These glib claims sound deep and meaningful as long as you don’t stop to think about them. But when you unpack the natural childbirth industry’s purported commitment to bodily autonomy for women, you find that it’s a mile wide and an inch deep.

The reality is that the natural childbirth industry is committed to bodily autonomy ONLY in regards to their goods, services and recommendations. If they were truly committed to bodily autonomy, they’d be counseling women to have epidurals and maternal request C-sections, perhaps the ultimate expression of a woman’s right to control her own body. The reality is, though, that if they can’t provide it or profit from it, natural childbirth advocates don’t support it, bodily autonomy be damned.

The principle of bodily autonomy is very simple: mentally competent adults have the right to control their own bodies.

So if natural childbirth advocates believe that pregnant women have the right to bodily autonomy, that would mean they have the right to choose what happens to them during childbirth. But that’s NOT what natural childbirth advocates mean. Their claim is a stunted, truncated version of bodily autonomy.

When natural childbirth advocates invoke bodily autonomy, they mean “the right to refuse medically recommended interventions in childbirth, and substitute them with the products and services of the natural childbirth industry.” The natural childbirth industry can’t provide or profit from either epidurals or C-sections so they demonize and oppose them.

How is the choice of an epidural an expression of bodily autonomy? Because pain robs women of control.

… Pain will potentially push birthing women into a non-rational space where we become other; ‘screaming, yelling, self-centered and demanding drugs’. The fear being articulated is two-fold; that birth will hurt a lot and that birth will somehow undo us as subjects. I consider this fear of pain and loss of subjectivity are vitally important factors in the discussions about risks, choices and decisions that subtend … reproductive debates, but they are little acknowledged. This is due, in part, to our inability to understand and talk about pain.

As she explains:

… [W]hen we are in pain, we are not selves who can approximate rationality and control; we are other and untidy and fragmented. When women give birth, they are physically distant from the sense of control over the body that Western discourses of selfhood make central …

Natural childbirth advocates are well aware that childbirth itself is uncontrollable. That’s why they emphasize giving in to, and reveling in the process. But most women have no interest in letting a bodily process control their minds and choices; they’d prefer to use their minds to control bodily processes.

Most women have no interest in letting menstrual pain control them for several days each month so they choose medications that can diminish menstrual pain and decrease heavy menstrual bleeding.

Similarly, most women have no interest in letting childbirth pain control them for dozens of hours. They choose epidurals to relieve that pain so they can be awake, aware and IN CONTROL as their babies are born.

Vaginal birth is even rougher on women’s bodies than childbirth pain. It can lead to everything from decreased sexual satisfaction to disabling urinary and fecal incontinence. Some women wish to take every possible precaution against unfortunate outcomes by choosing elective C-section instead. We can argue about the risks and benefits, but it is thoroughly disingenuous to argue as natural childbirth advocates do, that women shouldn’t be allowed to opt for C-sections by choice.

Arguments from bodily autonomy should be agnostic as to what women actually do with their bodies. If natural childbirth advocates truly respected women’s bodily autonomy, they’d treat all possible childbirth choices — epidural vs. unmedicated birth, C-section vs. vaginal birth — as equal and equally worthy of respect, but they don’t.

In my view, it is the natural childbirth industry who is perpetuating obstetric violence by insisting that women must be forced or bullied into enduring the violence of childbirth pain and vaginal delivery. They bully women because the natural childbirth industry believes it knows better than women themselves what is good for women — purchasing the products and services of the natural childbirth industry.

Agreed, true body autonomy would allow women to make an informed choice. It would be great if the medical profession would provide full evidence based information. This is what women want.

Angie Young-Le

This article made me think of a “documentary” called The Business of Being Born. When I read the title I innocently expected it to be about the baby’s journey through the birth canal, etc… BOY was I wrong! It was a propaganda piece by natural birth cultists. For a while I thought “They must be joking” but they were 100% serious. The whole time they were bashing modern medicine, claiming doctors are only in it for money and how home births are the “only logical option”. I laughed at how delusional the whole thing was….

Almost 23 years later and I still suffer from my vaginal delivery. My extremly small pelvis went unknown until I had my son.If I had known how small my pelvis was, I would have asked for a c section. I have scarring, incontinence and more. When I am sick with a bad cough, I hate how I feel like a baby because of the special pads I have to use. My husband, godbless him has been sweet and understanding through it all.

Thank you and I will always say this. It is worth it because I wasnt supposed to become pregnant.

demodocus

does anyone know the percentage of women who have babies vaginally who *don’t* have any lasting side effects (besides knowing way too many kid shows’ themes)

Azuran

Good question. But I’m not going to ask my mom or any other family member if they incontinence problems or other birth related problems. Although the recent discussion about the rise on incontinence pad adds on TV made me realize those very small pads I stole from my mom during my very light day of menstruation when I was a teen where probably not menstrual pads.

But yea, it really is a problem in the natural birth industry how they point out to the risk and complications of everything but act as if vaginal birth was 100% risk, complications and sequel free.

Who?

I don’t. I’m 53, my kids are 21 and 24, and I haven’t ever had incontinence or anything like what people are describing. I’m small, they were big and late, labour was fast both times: 6 hours from ouch to hello. There was a smallish tear with the first one, which was stitched up by the hospital midwife (they were born in the UK).

I consider myself extremely fortunate after reading what has happened to many commenters here. Most of my friends had cs and I’m not hearing any horror stories from them. We are sharing menopause stories at the moment, so I think I’d be hearing if there were problems.

Others here are mentioning all the ads for incontinence products, and I agree there is clearly a market for such things, and in younger women than we normally associate with that problem. By the look of the ads, younger women than me.

BeatriceC

I’m 40 and have been using incontinence pads for, um, how old is my oldest? Yeah, nearly 17 years now.

One of my favourite journalists at the Guardian, saying very sensible things.
The comments, as ever, are Guardian woony tunes.

Anna

“Vaginal birth is even rougher on women’s bodies than childbirth pain. It can lead to everything from decreased sexual satisfaction to disabling urinary and fecal incontinence. Some women wish to take every possible precaution against unfortunate outcomes by choosing elective C-section instead.” And besides the possible vaginal birth horrors… There are c-sections and c-sections. I wouldn’t exchange my relatively calm elective one for an extra-crash emergency one. Because it’s the emergency c-sections that are made into c-section horror stories later. When every single moment matters things can get really brutal. That’s where we get the stories about failed anesthesia and purple non-breathing newborns from. For a woman who is a poor vaginal birth candidate the choice is pretty hard. Go for it and hope it turns out well or request a c-section in advance.

Dr Kitty

The emergency crash CS went by “smash and grab” where I worked.
For a reason.
Anything where you have to get from skin to baby in 4minutes or less, by necessity is not going to be pretty.

Both of my elective CS were under 25minutes from the first cut to the last suture, and we still had time to laugh and joke with the staff, they could tell me that baby #1 was sunny side up and #2 had lots of hair before they were out and everything was very chilled.

The second time the OB even made the effort and took the time to cut out my old scar (which wasn’t that bad) and make the incision as neat as possible. No one was under pressure, everything was on schedule and going to plan and it was obvious.

sdsures

“The emergency crash CS went by “smash and grab” where I worked.”

I’m going to think of CS as “smash and grab” from now on, just because it makes me smile.

Rosalind Dalefield

But shouldn’t it really be ‘slash and grab’?

sdsures

Heehee! Yes! “Extract the parasite!”

BeatriceC

I’ve already stolen the “smash and grab” phrase and have used it repeatedly. It aptly describes the birth of my youngest. I didn’t realize hospital beds could be pushed so fast down a hallway. Really, the “hospital bed dash” should be an olympic sport.

CSN0116

The crunchiest dumb fuck I know (through my husband, purely acquaintance), had to include that #1 was born without pain relief, and that #2 was the birth she dreamed of, at the home of her midwife (she lives too far from a hospital to make it “safe”). She also posted a pic of her newborn drinking a bottle to fb once, but was sure to state, “Baby drinking expressed breast milk.” GAG. This woman is anti vaxx, thinks foods can cure cancer …she is my mortal enemy and I hate her face 😀

Roadstergal

I got a mass-email birth announcement from an acquaintance’s husband earlier this afternoon – a very short one, with name, weight, time of birth, and right after that, “[name redacted] managed to have a natural birth.” What the fuck has happened to birth announcements. “My wife was in excruciating pain that could have been safely relieved, but now we can feel smug about our achievement.”

Deborah

My birth announcements, in the paper, used to read something like this: ” (baby’s name) born safely at home. We would like to thank God, our midwife (name) and all the saints who upheld us in prayer”
Please don’t laugh – I cringe now to think of it. For me, it was not so much a feeling of smugness but I loved being able to show, in print, that the baby had been born safely as that is what everyone “who just don’t understand how safe homebirth is” wants to know. See! I did it again and it’s safe! Also I had to thank God because I have faith people! More faith than you! Thanking the midwife went without saying as, “midwife? What the heck is a midwife?” And lastly, thanking everyone who prayed for us, knowing with almost certainty that no one did.
Yes, there’s a lot in a birth announcement.

On the other hand people humble enough to realize they were on a irrational path and smart enough to understand why are very few, and you’re obviously one of them :).

fiftyfifty1

“And lastly, thanking everyone who prayed for us, knowing with almost certainty that no one did.”

Really? No one? That’s funny, because I’m an atheist who was raised very religious. I haven’t prayed in years. But whenever I hear of any acquaintance/friend taking an NCB-influenced risk, I come very close to resuming old habits (and sincerely so). Oh Dear God, let them be safe!

Deborah

Lol – yes for sure, I hear you.
I’m struggling my way through three books at the moment: Sex and God – How religion distorts Sexuality: Breaking Their Will – Shedding Light on Religious Child Maltreatment and: Leaving the Fold – A guide for former fundamentalists and others leaving their religion.
My comment was probably a reflection of my current negative and definitely jaded state of mind. 🙂

fiftyfifty1

It’s a strange journey leaving a religion.

Bombshellrisa

I really need to read these.

sdsures

That bothers me, too. Seriously, THAT’S their priority? Not whether it has all its fingers and toes?

I really wonder often how much fathers are involved in NCB stories.

Erin

My husband texted our nearest dearest “they both survived separation”. My mother said if I get pregnant again, she’d rather wait until I’m capable of using a phone than getting his attempts at a birth announcement.

My geeky nephews found it funny as to them we’re clearly some sort of transformer spaceships pretending to be human.

KeeperOfTheBooks

Now see, that would have cracked my (oh-so-geeky) self up, but I can see that it wouldn’t, perhaps, be the ideal general birth announcement. 😉

SF Mom & Psychologist

I honestly think that 100% of the women I know who had natural vaginal deliveries indicated that somehow in their emailed birth announcements. Sometimes it came from them, sometimes it came from their partners. But they all exercised their “bragging rights” with varying degrees of subtlety or obviousness.

MrsLady

Spelling correction: “Elisa Alpert” should be “Elisa Albert”.

OBPI Mom

30 hours of back labor during my homebirth and the out of control pain it caused… I never felt so out of control and “out of it” in my life. I was pissing and letting meconium drip on every floor in my house (every single floor), stark naked, AND DIDN’T CARE while screaming that my “ass is breaking in two!!!” Then he was born and all that chaos because he was stuck and flat when pulled, but I didn’t even comprehend what was happening… and honestly I didn’t feel anything. I knew my arms hurt (from holding people’s arms when pushing for 4-1/2hours) and when my son was resc’d I didn’t want to hold him because I was exhausted from the pain and my arms hurt. Super empowering! I was so surprised when I had my first C-section how “with it” I was. How I could talk to someone while my baby was born and really look at him. I loved how controlled and peaceful my 4 C-sections felt, esp. after feeling the exact opposite during my homebirth. (not to mention healthy babies!!!)

Karen in SC

Have missed you OBPI Mom! how are you?

OBPI Mom

Good! Busy with Baby #5 being mobile now and Springtime on the farm upon us. Catching up on some reading during rainy days though!

sdsures

I pee and poop in solidarity with you. You are not alone!

(I have incontinence issues, and have just learned to roll with it – so has hubby.)

Phoenix Fourleaf

Also, birth pain can and does cause PTSD, or it can make it much worse for trauma survivors who already have it. I know for a fact that my unmedicated births retraumatized me and sent me spiraling into a post partum Hell of depression. I would strongly recommend that survivors of sexual trauma consider opting for an epidural, or at least have your baby in the hospital so that an epidural is available to you if you need it. Retraumatizing yourself for the sake of a so called natural birth just isn’t worth it.

yentavegan

Strong self assured educated women who do their research and surround themselves with a like minded support system have less painful more empowering births. The ability of the human mind to control labor and delivery needs to be promoted. We need to take back birth from the medical industry and place it where it belongs, in the capable hands of the mother. We can be conduits for a more peaceful world starting with how we approach birth. All the pain relief a mother truly needs is deep cleansing breaths and focal points. We mustn’t teach fear of the birth process, rather we should teach awe and trust of our bodies’ ability to do the job nature designed it to do

. When and how and where this ideology made it’s way into my life, I can not pinpoint. My mother cared not for the birth experience, her only goal was a healthy infant and to survive our births.
How did the message of Natural Childbirth worm its way into my life goal? I do not know.

Allie P

Good point.

Rosalind Dalefield

I have a pretty good mind, judging by my academic achievements, but it couldn’t change the shape of my pelvis (android) or the lie of my babies (posterior). Labor and delivery are at the mercy of things a woman’s mind can do nothing about, including the myometrium (which is smooth, involuntary muscle), the pelvic shape, the baby’s size and presentation, and the mother’s endocrine status. The ability of the human mind to control labor and delivery needs to be dismissed as the nasty, mother-blaming myth that it is.

Phoenix Fourleaf

Thank you!

Dengar Rebo

It’s kind of perverse. The previous commenter is, in the one hand, blaming women who experience pain differently than her for being weak and incapable. But then, on the other hand, she is placing women above evidence-based medicine when she states that mothers know more than medical professionals. She is essentially cutting women down and building them up too high at the same time.

Rosalind Dalefield

It never seems to occur to those who sneer at women who use more pain relief than they do, that the difference may not lie in ‘pain threshold’ or ‘pain tolerance’ but actually in how much it hurts, in that medical science actually knows that when the baby is not moving down normally, the first response of the uterus is to contract harder. Which is likely to hurt more, duh. If the uterus has to try really hard, the contractions actually become less effective because instead of generating a nice peristaltic wave from top to bottom, the uterus starts more or less snapping in and out without the progressive wave.
I vividly remember how, when my daughter abruptly wriggled around from an anterior to a posterior presentation when I was already 6 cm dilated, the contractions abruptly went from ‘strong but I can cope’ to ‘get me that epidural right now’. The CTG trace confirmed what I could feel; the contractions suddenly got much stronger.

Gia Rebecca

Lol your academic achievements, according to your website, are not that outstanding … plus they are from Massey which barely counts as a university.

Rosalind Dalefield

Have you got anything other than ad homs and lies?

Who?

No doubt you are a total genius with a string of academic and professional qualifications from a number of top level institutions?

Thought not.

Gia Rebecca

LOL think again. But first you will have to figure out my real name to be able out find my CV etc.

Amazed

Are you this interesting? I wouldn’t waste my time for someone comparing childbirth and chronic conditions. Not exactly queen of logic material here.

Gia Rebecca

LOL again you clearly didn’t read the thread properly, as I was replying to someone who specifically asked about what other conditions other than childbirth …hence I gave an example that was NOT childbirth where the mind is used to help with pain. Also, chronic pain is just one example. Acute, short term pain for which morphine isn’t helping, is just the same. Have you never been in hospital after surgery?

Nick Sanders

One, clearly we can add “analogies” to the list of things you don’t understand. Two, “Acute, short term pain for which morphine isn’t helping” implies that morphine has already been given, as opposed to skipping straight to the meditation and happy thoughts.

Azuran

and here, you said it: AFTER morphine.
Breathing exercise and other ‘mind’ stuff should only be considered proper methods of analgesia after other, way more effective methods have failed. Not as a first line treatment.

Gia Rebecca

Really. Ever heard of the IMO? Maybe go google that and see if you can solve even just one IMO problem, let alone make your country’s team 🙂

Gia Rebecca

Umm pretty sure I wasn’t replying to your comment, I was replying to the person who tried to tell me I had no qualifications LOL. Why would you be interested in my qualifications?

momofone

Would it surprise you to find that no one actually cares enough to play?

Gia Rebecca

Again, pretty sure my comment was only directed at one person – the one who cared enough to bring up my qualifications. Not sure why you would care at all, but clearly you care enough to comment haha

momofone

What are you, twelve? “haha”

Gia Rebecca

nope, close enough though. I’m curious what kind of adult /mom would spend so long on an internet forum when you could be like you know looking after your kids.

Azuran

Don’t know about you, but where I live it’s almost midnight. Are your kids still up at midnight?

Not past kid bedtime here, but mine are teenagers so they don’t need me to entertain them 24/7. Come to think about it, even young kids don’t need a parent hovering over them 24/7. Being in the same room so you can keep an eye on them, yes, but one doesn’t need to do nothing but stare at one’s kids all the time.

momofone

I’m not even in the same room necessarily–he likes doing his own thing and checking in every once in a while, and I love it!

BeatriceC

My general rule when the kids were little was “in eyesight”. Of course, my kids were very creative in the trouble they could get into. All of my best stories of their toddler and preschool years start with “I had to go to the bathroom”.

momofone

Mine’s nine now, so it’s a really fun mix of letting him try out his independence and being available for his top-ups of snuggling and doing things together.

BeatriceC

I think around 9 the my general rule was “within earshot”. Mine are 16, 14 and 13 now (though birthdays in May and June), and they’re all extremely independent. The older two haul themselves all over San Diego County on public transportation independently and safely. The younger one isn’t quite as independent, but he has medical issues that keep him from having the freedom his brothers have.

Who?

Judgy, aren’t you?

Gia Rebecca

Also, if you think I’m 12, what does that say about you, given you can’t help aruging with me? haha do you like enjoy arguing with 12 year olds or something?

Who?

Not interesting.

But thanks for playing.

Gia Rebecca

Not that hard to verify my academic achievements if you are smart enough to figure out my real name and look up my CV lol.

Gia Rebecca

The human mind can’t control labour, but there are various ways in which it can modify how we experience pain.

Rosalind Dalefield

*there*

Gia Rebecca

? ?

Gia Rebecca

Haha did you only read the email version of my comment before realising I had corrected my spelling mistake immediately after posting? haha kind of makes you look like the idiot here. Also, like seriously who even comments on others’ spelling/grammar on an internet forum? Like seriously what point are you trying to prove? That some of us can’t be bothered taking the time to spell check everything we write before posting? umm you do realize this isn’t a university essay…

momofone

You can’t decide which side of the fence to sit on, can you? I’d love to hear how your sloppy writing makes someone else “look like the idiot here.”

Gia Rebecca

I think some one who is so eager to find a spelling mistake to correct in another’s comment, in order to win some kind of grammar competition, without actually reading the comment on the website, is a bit of an idiot or maybe has in inferiority complex is a better description lol.

momofone

I see. So you write like a seventh grader, yet you believe your credibility shouldn’t be questioned because it’s obviously the readers’ fault. And you throw in “lol” and “haha” as if you’re texting your BFF about the math test in third period.

Azuran

and yet, only in childbirth do we pretend using the mind to control your pain is appropriate. Everyone else in any other painful situation gets actual analgesia.

Gia Rebecca

Ah no that is actually not true at all. Plenty of people e.g. those with chronic pain are taught mindfulness based skills etc to help them deal with the pain.

Nick Sanders

How many births last long enough to be considered a chronic condition?

Gia Rebecca

umm maybe go back an read the last few comments again … Azuran was asking about situations OTHER THAN childbirth where mind-based techniques are used. Hence I gave an example that specifically was NOT childbirth.

Nick Sanders

Go back and read, there was no question asked:

and yet, only in childbirth do we pretend using the mind to control your pain is appropriate. Everyone else in any other painful situation gets actual analgesia.

You got called out, and now you’re trying to dodge.

Gia Rebecca

Sorry, you are right, it wasn’t a question, it was a statement, made out to be a fact, when it wasn’t in fact a fact. Nothing to dodge here- google mindfulness +pain and there are hundreds of studies on this.

Nick Sanders

1. How many of those situations are both acute and use “mindfulness” as a first line treatment?
2. Do you realize there is more to a successful birth than just managing maternal pain? Because at this point is doesn’t seem like you do, or if you do, you don’t seem to care.

Azuran

I didn’t asked about IF they where used. I asked about when they are considered an appropriate form of analgesia in themselves.

BeatriceC

But you’re still wrong. People with chronic pain conditions are sometimes taught mind-based techniques to cope with chronic pain *in addition to* medication, physical therapy and other medical-based techniques.

Amazed

She meant it like “excruciating, intense, but thankfully not longtern pain”.

I thought someone who bragged about their academic achievements would have the brains to figure it out. Not exactly a nuclear silence.

Gia Rebecca

What is a nuclear silence?

Amazed

Wow! Given your lenghty reply to RD, I’d think you’d be able to figure this one as well. Clearly not.

Gia Rebecca

Nope, I’m sorry – as you said, logic is not my strong point, so I didn’t want to guess, Thought it was safer to ask – maybe a nuclear silence is some genius-type thing that only smart people like you have hear of?

Azuran

Yea, once everything else failed and they are still in pain despite medical treatment. Not as the first treatment. Nobody is suggesting those with painful chronic condition to just just not get any kind of pain medication and ‘breath through it’

sdsures

So, a birthing mom needs, in effect, only yes-men?

That never worked well in politics, so how can it be the same for birth.

Rosalind Dalefield

“We mustn’t teach fear of the birth process”
I’ve posted this on the Skeptical Ob’s blogs before, but I’m going to say it again. I would argue that fear of the birth process is in fact normal for the human woman, and throughout history and prehistory, women have been afraid of childbirth because they knew it could kill them. They saw plenty of examples around them. It’s really not that long ago that the first thing a woman would do when she found out she was pregnant was to write her Will. My personal theory about the ‘Venus of Willendorf’ statuettes from prehistory is that they were not fertility goddesses or sexuality goddesses, but good-luck charms against death in childbirth.
While there is evidence that if you agitate a cow or sheep during parturition, then labour may be more protracted, I am not aware that there is any quantitative evidence that a human mother who is afraid of her labour not going normally is going to have a longer labour than a mother lulled into a (false) sense that nothing can go wrong. What women should be taught is that a lot of things can go wrong, but modern obstetrics has solutions that mean that mother and baby still get a good outcome.

Jules B

I didn’t get my epidural until I was pretty much ready to push, because no one had any idea how far along I was because I wouldn’t let anyone check me mid-contraction (and they kept coming in to do it mid-contraction). Side note: So much for them not respecting my bodily autonomy…they did indeed listen to me when I yelled, “If anyone comes near me right now I will bite them! Not joking!!” Hah. Anyway, the lovely (and very handsome, btw) OB on-call OK’d my epidural without a check because he saw how much pain I was in with induced back labour. His exact words were, “Oh is it back labour? That’s awful! Yes, give her the drugs!” (So much for that OB being violently unsympathetic right?). After it kicked in, he stayed with me for the whole hour I pushed, making me laugh by saying things like “I promise you won’t poop on me. I am an expert poop-dodger.” Funny and handsome, I may have developed an insta-crush right in the middle of it all ;-). That epidural made the last part so relaxed and wonderful – best part of the whole thing (until the moment I saw my baby, obviously). Epidurals for the win!

EmbraceYourInnerCrone

Why did they need/want to know how dilated you were before giving you the epidural? If you were in pain why was that not reason enough? I do understand occasional cervical checks just to make sure that labor is progressing/not stalled but them wanting to do them mid-contraction was kinda not cool…

Rachele Willoughby

Idk, I ended up without an epidural due to how far dilated I was since my oldest daughter crowned while they were trying to insert the spinal catheter. I imagine that after that the anesthesiologist (who, for the record, didn’t believe me when I told him why I couldn’t sit still) was wary of late epidurals for the rest of the morning.

Needless to say, when they asked me if I wanted an epidural with my youngest son. I told them (with a heavy heart) not to bother since I was already 8-9cm and my second stage lasts minutes, not hours.

*sigh* I always dreamed of having an epidural…

EmbraceYourInnerCrone

I had one but would REALLY have appreciated getting it much earlier. I had about a 6 hour labor total. it was fast but really painful and contractions went from 20 to 7 to 5 to 2 minutes apart in about 2.or 3 hours if that. it took them 2 tries to get the epidural started I was about 4 or 5 cm when they started and 9 when they finished. if there had been a next time I wanted it BEFORE labor started.

Chant de la Mer

LOL in my last labor I walked into triage asking for the epidural, alas I never did get it because I had precipitous labor and delicate veins. So they couldn’t get a blood sample and the anesthetist refused to do it without the blood test. By the time they got the sample and the IV in, which was nerve wracking as I was supposed to get two rounds of IV antibiotics for GSB, I was pretty much blowing through transition and baby was almost crowning. Next time I would want it before labor too!

Jules B

Yeah, it is a teaching hospital so I think them trying to check me mid-contraction was partly due to lack of experience/bad timing on the nurses’ part. They didn’t seem to be paying attention to their window of opportunity.
Re: knowing how dilated before administering an epidural. Maybe it is different where I am in Canada, but most hospitals/doctors do seem to want to know where you are at, labour-wise, before they sign off on an epidural. I know women who have been told they are too far along for one – like, my best friend, who only had time to pull off her pants in the delivery suite before her second was born because the baby came so fast, was asking for an epidural but was told, “Nope, the baby is literally here! No point!” They also seem not to want to give one if you are too early on in the process, as well. Again, I have had friends who were told, “Not until you are in active labour.” Maybe it is a cost-savings thing? Or maybe there are valid medical reasons behind it…

AirPlant

I think I had heard that epidurals wear off? So the idea is that if you give it too early you risk it wearing off and not being able to administer in time to block the worst pain.

Rosalind Dalefield

In my country they slip a catheter in and top up as required.

Monkey Professor for a Head

I had a patient controlled epidural, so I could just hit a button any time I needed a top up. It was great!

sdsures

Sounds fab!

Monkey Professor for a Head

It was! I could top up when I needed and then back off when it came closer to pushing time. It didn’t quite cover the right side of my stomach, but it took away the back labour pain, which was a massive relief. And I had great perineal coverage – pushing actually felt good, and when I needed an episiotomy and then some sort of cervical check due to bleeding, I felt nothing. I was lucky that the anaesthetist on call was the head of the pain service, so he really knew what he was doing. I meant to send him a thank you gift, but never did get around to it – maybe I should do it for my sons first birthday 🙂

KeeperOfTheBooks

I should think he’d appreciate it very much, even if just a “thank you” card.
When I had my first ultrasound this time, I took the opportunity to tell the US tech that she’d been dead on at her weight estimate for DD a couple years prior–she’d estimated 8 pounds, and DD came out at 7 pounds 15. She was delighted; as she put it, “no one ever comes back to tell me how close I was!” Seemed no end pleased to hear that she was very good at what she does–of course, who doesn’t like to hear that?

sdsures

That sounds like a nice idea. I’m sure he’d appreciate it.

sdsures

Can’t they top it up? That’s why there’s a tube attached, isn’t it?

Azuran

Maybe there’s a max amount of time they can top it off? Maybe they keep the tube in case there is a need for emergency c-section and that’s an exception case? I’m not sure.

MI Dawn

Whether it’s true or not, I was taught as a CNM to wait until they were in active labor usually (4 cm or so) to prevent the muscle relaxation allowing the head to not engage well. Also, because sometimes giving them too early in labor would slow down or stop the contractions.

However, if the head was well engaged, we would order them earlier (if requested by the patient), for inductions or people otherwise on pitocin. We did like to hold them off until then, if possible, preferring to have patients up on their feet and walking or in the shower for pain relief.

Roadstergal

Dr T had a post not too long ago on the 4cm thing – I posted a link just above.

MI Dawn

Missed that link…Guess I need to refresh more. Thanks.

Toni35

That strikes me as ridiculous (on their part!). A contraction only lasts a minute or so… What did they pop in the room at the beginning of a contraction, hear you say, “no you’re not checking me now” and just leave before the contraction was over? They couldn’t wait a moment for the ctx to subside and then ask to check? That’s just nuts. Or were they misinterpreting you “not right this second” as “not at all”?

Jules B

I think they thought I meant “not at all,” yeah. Mostly because of how I said “go away” – I said it rather forcefully, but duh, I was in severe pain! That is where their inexperience came in, I think…I literally scared them off! More experienced nurses would have not been scared off. Note: those two nurses who were in training who were supposed to check me, had me as their (teaching) patient because they had initially put in the Cervidil insert that started off my induction process. And during that Cervidil insertion one of them was literally digging around in my vagina to get it placed right, and I said loudly “OW!!” It hurt, and I let them know it and asked for their supervisor to do it (which she did and it did not hurt at all). So yeah, I think that earlier experience with me had spooked them haha.

Jules B

Oh, also to clarify on my last reply – I think they were trainee doctors not nurses. Maybe.

sdsures

“They also seem not to want to give one if you are too early on in the process, as well. Again, I have had friends who were told, “Not until you are in active labour.” Maybe it is a cost-savings thing? Or maybe there are valid medical reasons behind it…”

That smells like manure.

Jules B

Yeah, just what I have heard from a few friends, so not sure if it is standard practice. Someone posted a link (sorry, cannot find it now?) from an old post of Dr. Amy’s where she mentions a study that supports the idea that women can get epidurals st any stage and it does not affect outcomes. So maybe some places are working with old data? I don’t know, I am not a doc or a scientist, just a former English major 😉

sdsures

“Cochrane Reviews: Women in Labor Can Get Epidurals Right Away” – something like that.

Former Russian major here. I did stats as part of the work for my second degree in psychology, but I have not returned to finish the psych degree due to health issues. If I get healthier, I might go for graduate Russian studies.

I don’t think we NEED to be science majors to have a healthy respect for statistics and science, but it does help if you understand the basics, which one can do with enough will these days, thanks to the ole Interwebs.

Jules B

True true! I had to give myself a time-out on the Internet while I was preggo because it was messing with my head ;-). I have learned a lot since then, thanks a lot to this blog, actually.

sdsures

Me too (re learning a lot).

Azuran

Well, if the baby is literally right there, there is indeed no point in the epidural, the baby is going to be out way before you can get the epidural in.
As for too early, I’d guess it’s because epidurals only works for a certain amount of time? if you get it too soon and the labour lasts a long time, maybe it runs out? So they try to get it at the beginning of active labour? I dunno, didn’t have a baby yet so I don’t really know how they work.
But financially it changes nothing if you get an epidural right now or 3 hours from now, it’s still the same cost, and I doubt that actual OBs would delay epidurals on purpose as much as possible until it’s too late to get one in order to save money.

anyone else here have the OB start sewing up tears and/or episiotomy with out a local? (fyi they had turned down the epidural they said, so I could push because she needed to come out NOW. ) But then the doc started sewing up the 2 tears and episiotomy without a local. Hurt a lot. I was asking for a local/crying but he did not hear(or ignored me) so my husband stepped over and said She says she is in pain from the stiching! please use some Lidacaine/Novacaine please. This was 1994 but it’s still one of the things I would change about the experience if I could.

Guest

I didn’t have that experience, but that’s terrible. When you go in for sutures they don’t just stitch you up with no pain relief unless there’s some reason they cannot. Someone should ask that doc how he’d feel having stitches put in his junk without pain relief.

sdsures

I’ve had staples taken out of my scalp (hydrocephalus surgeries), and they hurt like **** when it happens, even though the nurse was relatively fast. Even though I was an adult, I screamed the place down.

Most neurosurgeons, I expect, in scalp incisions, prefer staples to sutures when possible and depending where they are, because otherwise, incisions can pop right open! None of mine have ever popped open, thank goodness, but I know someone else who has hydrocephalus, who has had that unfortunate experience. It is definitely a most bizarre feeling when you have staples in your scalp.

sdsures

I wonder what the incidence is of staples vs stitches in obstetrics?

momofone

I don’t know what it is overall, but when I was being prepped for my c-section, I asked the people in the OR if my OB did staples or stitches. They said they had only known him to do staples, but that if I had a preference, I could ask and see what he said. I asked, and he said he’d be glad to do stitches (though he almost always did staples), and he said no one had ever asked before.

fiftyfifty1

I got some experimental “dissolvable staples” that were supposed to be the best of both worlds. They ended up being the worst of both worlds, and I was picking out festering remnants weeks later. It’s the only thing about my CS that I would go back and change if I could (and that’s a pretty minor thing).The rest was lovely.

sdsures

Interesting.

KeeperOfTheBooks

Glue is also an option, and how my OB closed my incision. I’d rather that than either staples or stitches. The only problem I had with it was a little “end” of glue sticking up and causing very minor annoyance, and he snipped it off at the two-week appointment with no muss, fuss, or even discomfort. I’m sure it’s not an option for vaginal/perineal repair, but it worked brilliantly for the CS incision. It eventually wore off, and that was that.

sdsures

Nice!

guest

I’m not sure why this was directed at me since I was talking about straightforward sutures, not scalp staples. They sound awful. I had staples for an appendectomy and they didn’t hurt at all coming out. I think the head is more sensitive, as are the genitals.

Angharad

My OB specifically told me to give myself another dose of epidural when she came in to deliver the baby, because stitches were imminent (I had the kind of epidural where I could push a button to get another dose every 15 minutes if so desired). I was glad because the stitching took over an hour and I didn’t feel any of it. I can’t believe they would expect you to just sit for stitches in a very sensitive area without trying to minimize the pain.

Chant de la Mer

I had unfortunately been unable to get my requested epidural, I will say that getting sutures in sensitive areas is much easier with the epidural in place and that had actually been the argument my husband used to convince me to ask for the epidural in the first place for the last baby. I warned my L&D nurses that they had better use extra lidocaine when they had to stitch me up because I’m resistant. The midwife listened but the OB who came in (the awesome one who had just saved my baby’s life) hadn’t heard that part and didn’t realize they were waiting for the anesthetic to kick in and jumped right in with the suturing as the midwife murmured oh she’s anesthetic resistant . . . right before I nearly kicked the OB. She apologized right away and waited a few more minutes.

Irène Delse

It happened to my mom for her first two babies, in late 60s – early 70s. First baby, shoulder distocya that needed an episiotomy. The OB stitched her up with no anesthesia but according to her, she didn’t feel pain “down there” at the moment. Of course, she also says she was so exhausted by that time that it might as well have been natural analgesia.
Second baby, same story except that it was a vaginal tear needing repair. No analgesia, and no pain according to her: after the labour, she “didn’t feel much” in her nether regions.

Of course, people process pain differently. For my mom, the shock was her first childbirth, a natural one as intended: vaginal, no pain relief, minimum interventions. Luckily for her, it worked, but she admitted later that she felt a surge of panic when the contractions started in earnest. She didn’t ask for pain relief mostly because the nurse-midwife bullied her into “shutting up and pushing”! It was the time of patronising hospital personnel, and this hospital didn’t believe in pain relief for childbirth, apparently.

guest

Holy crud. I was just looking for more info on back labor to try and figure out if that’s what I had. This americanpregnancy.org page has a bunch of ideas, but what I noticed is that in the section about how to relieve the pain they don’t even mention an epidural or other drugs as an option.

And this is how people get sucked into woo. “AmericanPregnancy.org sounds like an official medical organization, not a natural birth site. You get woo information and you don’t even know it.

Jules B

I remember stumbling across some stealth woo sites when I was pregnant, and thinking, “Hang on, this seems…odd.” Very tricky of them! Regarding back labour – I was actually managing the pain OK for most of my labour, but only because the L&D nurse on shift then was applying some expert counter-pressure to my lower back. And the fact that I was standing. When she went off shift, the next nurse on couldn’t do it as well, plus I was going into transition, and that is when I was like, “Ok, drugs, yes.” (I wasn’t trying to be a hero with the no drugs thing before – I am just neurotic and had this fear of becoming paralyzed if I got an epidural). But just before I got the epidural, the baby turned the “right” way round and I knew immediately. I suddenly felt the contractions up front, not up and down my back. I still hurt a lot but it felt easier to work with, somehow? (I still got the epidural though, because eight hours of standing while having back labour had exhausted me and I didn’t know if I’d have energy to push otherwise).

guest

I did okay unmedicated (induced) until it started feeling like intense rectal pain. Not like I had to poop, but like there was something seriously wrong with my rectum. I had a doula, but her attempts at counterpressure made me feel worse. But the epidural was just lovely.

sdsures

Pro Tip: When evaluating a pain management plan, ask yourself, “Would a grown man be asked (read “pressured”) to use this pain relief method if someone had just punched him in the balls with a medieval spiked club?”

I think you’ll find the results consistent upon repeating this experiment.

Allie P

An epidural absolutely contributed to my feeling of bodily autonomy. No one can think straight doubled over in pain.

sdsures

A-freaking-men. Pain disorts personality, as well as reality.

Jessica

One of my biggest regrets after having my first baby four years ago was that I did not get the epidural early enough in the labor. By the time it was in place and working I had already been pushed to the limit by a painful and rapid induction, and could not understand much of what was happening to me. It was frightening. In the end I felt shell-shocked by the entire experience and terrified of having another baby.

When I gave birth last month I requested the epidural as soon as I threw up from the pain. I was 3.5cm dilated and only three hours into the induction. I requested adjustment of the epidural twice when it was obvious I wasn’t getting full coverage. I was happier, more aware of what was going on, more relaxed, and more rested when I reached the second stage (which was much shorter the second time around). My husband commented repeatedly how much easier the labor was for me this time around. Effective pain relief makes a huge, huge difference and I believe it is partly why my recovery and bonding with my baby has been much easier this time around.

Heidi

Your birth sounds similar to mine. I was already at 4 cm., amazingly without any painful contractions. They induced me. They thought I’d labor for hours and hours thus recommended I wait on an epidural and walk the halls after they broke my water. Within minutes of my water being broken, the very painful contractions piled on. I requested the epidural right then and there! I was throwing up every few minutes and I was never able to actually not have a contraction while they administered the epidural. The epidural was seemingly not working so they rechecked my cervix and I was at 9 cm! This all happened in under 2 hours. By the time the epidural finally kicked in, (after a few re-doses), which was absolute heaven, I was at 10 cm. I was in too much agony before the epidural kicked in to even try to push. I’m not sure if I could have even told you what my name was.

Brooke

Wow. Now having vaginal birth robs women of sexual satisfaction & bladder control? What complete and total bullshit. This blog is becoming more ridiculous and predictable every day.

Monkey Professor for a Head

Not all women, but it does for some. Why do you have the right to discount their experience?

Bombshellrisa

It’s a risk of vaginal birth. It’s not discussed a great deal and it really needs to be. Since you fancy yourself a feminist, I thought you would at least know about this issue. Imagine that not every woman who gives birth has an outcome and recovery like yours. Try watching “A Walk to Beautiful”. All the women had home births, some were even UCs.

Emma

The risks of c-sections are openly discussed, and the so-called “risks” of formula feeding are not only openly discussed by aggressively drilled in our minds. There are issues that come along with vaginal birth too – vaginal injury and urinary incontinence are risks of vaginal birth, and the loss of control during an un-medicated natural vaginal birth is terrifying and traumatic for many women. We are upfront about the true risks and issues with c-sections so why do we gloss over the risks/issues of vaginal birth? Every woman is different and every birth is different. Not everybody will have every or even any of the risks or issues, but they deserve a full picture not a skewed version. It isn’t ridiculous to show them the full picture.
The home birth community advocates for a woman’s right to chose what happens to her body, and point fingers at the medical for controlling women and pushing too many unwanted interventions on them. But lobbying against c-sections and epidurals, restricting access to medication & formula, and shaming women who are considering any of the above until feel pressured in something they don’t want is just as controlling. So is glossing over the issues women struggle with and pretending they don’t happen, while painting a perfect picture of the other side.

Glittercrush

It did for me. It hurt to stand. It felt like my insides were falling out. Standing to wash dishes hurt 8 months after I had given birth. Sex was awful. My tear (which was only 2nd degree and stitched by a pro) took well over a year to stretch out enough for sex to not hurt. I saw 3 different doctors who all said that no unusual damage had been inflicted, that this was just a normal recovery from vaginal birth. When I expressed concern over the fact I couldnt cough without wetting my pants, all of them said “That might not ever get better. This is just a part of having babies.” I was so upset. I was expecting an easy recovery. I thought all pain would surely be gone 6 months after birth. Nobody told me that those were normal side effects of giving birth. In all the reading I did nobody talked about that. Everything was “BIRTH IS BEAUTIFUL AND EMPOWERING MAMA!” I was in labor for 14 hours. I only pushed for 22 minutes. My labor was textbook easy. It took over a year for me to be able to enjoy sex again, and I still have to change pants after a coughing fit. My child is 3. So much for bullshit.

ola

Have you considered seeing a pelvic floor physiotherapist? They work with postpartum women to address these issues. Incontinence is common, and uncomfortable, but can very often be eliminated. OBs don’t talk about it, unfortunately, although in other parts of the world postpartum physiotherapy is part of the standard care.

fiftyfifty1

“Incontinence is common, and uncomfortable, but can very often be eliminated. OBs don’t talk about it, unfortunately, ”

Sigh. This sort of attitude is exactly what you’ll find if you google female incontinence. Promises that incontinence can “often be eliminated” with Kegels or physiotherapy. Insinuations that OBs either are unaware of this magical solution, or are aware but keep it a secret from their patients.

The truth is that pelvic physiotherapy is anything but proven. Urinary incontinence can, at best, be slightly improved, and that’s not even for sure. The studies that show improvement are often very weak–very short term and not controlling for the placebo effect (any treatment, including a sugar pill, will make women optimistically report that things have gotten “a little better” initially, but this reported improvement goes away). The best study, in contrast, was months long and required women to do multiple observed therapy sessions (to make sure they were doing the exercises right) and keep a detailed log of home exercises. It showed a whole lot of nothing for improvement.

moto_librarian

It helped my urinary stress incontinence, but it was not severe. It has done nothing for the bowel problems.

Amy M

My mom had that bladder sling surgery (for urinary incontinence) about 12yrs ago—she was in her early 50s at the time. She had had two normal vaginal deliveries when she was in her 20s. The surgery worked for her, though I don’t know the success rate for the general population, or if that kind of surgery is still done today. But it was pretty major surgery, and included a hysterectomy. I’m pretty sure Kegels were useless fo rher.

Rosalind Dalefield

That has had issues of its own lately with women having surgical mesh inserted to help with urinary incontinence, and then ending up with crippled by the mesh 🙁

The Bofa on the Sofa

I mentioned above about the commercials for Poise, but I’ve noted before the lawyer commercials for vaginal mesh. As I said at the time, vaginal mesh surgery is so common that there are enough bad outcomes for lawyers to be chasing after it.

Again, a dirty little secret that no one talks about.

Rosalind Dalefield

That’s interesting. So the actual complication rate with surgical mesh isn’t all that high, then?

Glittercrush

I did not. The OBs I saw were thorough in their exams, and did give me series of excersizes to do what I could to help. I was not upset at the doctors for not having a magical solution. They took good care of me. I guess I was just upset that I had been blind sided by the knowledge that this was what was actually normal and expected.

Linden

Wow, Brooke, you’ve obviously not talked to that many women. Or they’ve realized what a blinkered idiot you are about NCB that they are not going to divulge any personal health issues to such a judgy person. Or you’re out and out lying. Hey, I think it could be all three!

As a certified nurse midwife with 50 years in the profession, I can tell you unequivocally that you have no idea what trauma can result from vaginal birth. I’ve seen women who required hysterectomies and major reconstructive surgery, and whose marriages were destroyed.

Obviously you had good luck.

Azuran

There you are. I was missing reading your ridiculous comments and opinion.
and wow, that must be one of the most stupid one ever. Vaginal birth can indeed cause incontinence and many women will feel less sexual satisfaction.
The whole point of this post is that, one again, you should let everyone decide what is best for them and what kind of risk they want to take for themselves.

Who?

You think you’re missing her, then she arrives, and you realise it was peace and relief you were feeling.

Azuran

I think it’s more akin to pity. She really needs to get laid.

Who?

Sure, but someone would have to do it.

Azuran

Ina May Gaskin maybe?

Bombshellrisa

And probably only if Brooke was in labor

The Bofa on the Sofa

I don’t know about you, but I have been noticing a lot more Poise
commercials on TV recently. It’s almost like it’s been a dirty little
secret that women have this problem with incontinence that is suddenly
getting a lot more attention.

So I wonder if Brooke, with her great knowledge of anatomy and physiology, has an explanation why incontinence is so common among women?

Sean Jungian

I have been noticing more commercials for female incontinence, too. I’m glad it is talked about more often and that it’s more visible.

I wondered partly if it’s because I watch more cable channels than regular broadcast channels, though?

Rosalind Dalefield

Whatever Brooke’s explanation is, I’m sure it will blame the victims of the incontinence.

The Bofa on the Sofa

Yeah, you’ve noticed that, too? “Oh, just do Kegels, that will solve it.” So if you still have problems, you haven’t done the right therapy, that’s all. Shame on you!

Rosalind Dalefield

Pregnancy, childbirth and breastfeeding are all fraught with opinionated people who find a way to blame the mother, aren’t they? It never seems to occur to them that they are just making the woman feel worse…or maybe that’s exactly what they intend to do.
I remember when I ended up with a forceps delivery because of a posterior presentation, I was told ‘Oh well you should have tried different positions in second stage’. As it happened, I did try different positions and none of them made a blind bit of difference, but the opinionated people didn’t ask if I had tried different positions before jumping in to tell me I *should* have. Then they’d say ‘Did you have an epidural?’ and when I said ‘Yes’ would immediately blame the epidural even though I didn’t get it until I had been in second stage for 2.5 hours and my baby was in desperate need of delivery. They never asked ‘WHEN did you get the epidural?’ before blaming me for having one.
Without knocking Kegels, if the incontinence is neurogenic then I rather doubt they would be much help. I had to wait for months to get back full anal and urethral control after my first delivery because the damage was neurogenic and nerves only regrow at about 1 cm a month at the most. Then of course I had to do the exercises when the nerves were back, because by that time there was secondary disuse atrophy. But now I am using big words that Brooke probably has never heard…

Bombshellrisa

Or she could ask her “feminist” mother, sister and friends unless they are as uninformed as she is.

Commander30

If it’s bullshit, could you please tell my body that? It’s been over eight months and I still unintentionally pee when I sneeze sometimes.

Mishimoo

Nearly 10 years since my first child, still have intermittent pain from a healed labial tear which impacts on my sexual satisfaction. I’m just lucky enough to not have incontinence despite a mild prolapse thanks to the third; but of course vaginal birth is somehow perfect. It’s not like my CNM warned my sister to tell her care providers if/when she gets pregnant about our mother’s android pelvis/emergency caesarean and my history of long labours with persistent occiput posterior position babies who insisted on having nuchal arms and cords along with one mild shoulder dystocia. Nope, vaginal birth is all easy breezy and no risk ever.

MI Dawn

Not every woman, Brooke. But some. Kegals don’t do it all. They help, but some women WILL have problems with sex, with bladder control, with bowel control. Even with my two fairly “easy” labor and deliveries, I have leaking sometimes with coughing/sneezing or if I wait too long to pee. I can leak even if I’ve emptied my bladder 2 minutes previously.

I’ve seen a therapist, and I’m working on the exercises. But don’t negate other women’s experiences. Just because something hasn’t happened to YOU doesn’t mean it’s “ridiculous and predictable”.

Daleth

And kegels don’t help if you have certain serious injuries. If a muscle is severely torn, exercising it isn’t going to help; it needs surgical repair. And if one of the levator ani muscles–key pelvic floor muscles that are anchored to your pelvic bones–gets torn away from where it’s attached to the bone, there is nothing you can do; there’s not even a surgical fix for that.

Dr Kitty

Vaginal childbirth CAN do those things. Not always. But it can.
Not always immediately, sometimes only years later, but yes, childbirth can cause physically and psychologically catastrophic consequences.

You might not be aware (which just means you are naive and ignorant), but it happens.

Sometimes the ladies who pushed out 9lb babies in their twenties have third degree uterine prolapse and severe urinary incontinence in their 40s and 50s. They require hysterectomies, pelvic floor repairs, bladder sling surgeries and physiotherapy.

Or doesn’t that matter because they’re no longer in their child bearing years?

What do you think the consequences of the following childbirth- related pathologies might be?

A perineal tear extending to the clitoris.
A coccyx fracture.
A vesico-vaginal fistula or recto-vaginal fistula.
A 3rd degree uterine prolapse (where the uterus falls out of the vagina).
A large cystocele (bladder prolapsing backwards into the vagina).
A large rectocele (bowel prolapsing forward into the vagina)
A Levator Ani avulsion.
An improperly repaired or badly infected second degree perineal tear.
A third or fourth degree tear (where the anal sphincter is damaged).
Pudendal nerve injuries.

2 million women around the world are living with the devastating consequences of obstetric fistula Brooke.
Is that complete and total bullshit too?

Brooke, you poor, dumb, sweet Summer child, you know nothing.*

Irène Delse

“Sometimes the ladies who pushed out 9lb babies in their twenties have third degree uterine prolapse and severe urinary incontinence in their 40s and 50s. They require hysterectomies, pelvic floor repairs, bladder sling surgeries and physiotherapy.”

Happened to my mother. Four vaginal deliveries, including two of big babies at 25 & 27, plus two smaller babies later in life. Urinal incontinence at 41 (BTW, kegals helped but not totally, she still needed protection pads), pelvic floor surgery at 50… Then a few years later, emergency surgery to repair an infection that had been festering on the site of the first surgery and was threatening her life. Had she known everything, maybe she’d have insisted on c-sections.

Dr Kitty

Sometimes you are exchanging an elective CS when you are young with a recovery at a time when you are ALREADY likely to be planning to stay at home with lots of family support, for a more extensive, riskier surgery 25 years later, when you might not be as able to take 6 weeks off work to recover or to recover as easily…oh, and years of incontinence and/or pain in the interim.

Irène Delse

I suspect that at 25, my mother would have chosen vaginal delivery anyway, since she wanted to have a large number of children. Then life intervened, children were a lot harder to manage than anticipated, and she stopped at 4.

All but 1 of the births were natural, but traumatic btw: first two kids were 9+ pounds, one with shoulder distocya, the other causing a 2nd degree (at least) tear; 3rd baby was born without major trouble, but 4th and last started her way in the world with profuse bleeding and a frenzied trip to the ED.

Chant de la Mer

“Sometimes the ladies who pushed out 9lb babies in their twenties have third degree uterine prolapse and severe urinary incontinence in their 40s and 50s. They require hysterectomies, pelvic floor repairs, bladder sling surgeries and physiotherapy.”

Yikes!! I’m going to have bad dreams about this now as I have had 3 babies 9lb and over vaginally! I already have minor stress incontinence and now I get to look forward to the day my female organs collapse in a decade or two, probably.
Well better to know than to be ignorant, I just hadn’t seen it so bluntly.

Dr Kitty

It’s not a given!
Don’t panic or anything!
But do be aware of any dragging sensations, a feeling of “something coming down” or lumps in the vagina.

My mother, at 65, having had four CS, does a twice weekly spin class and takes my kid to the trampoline park, having never had urinary incontinence.
My MIL, at a similar age, after three vaginal deliveries , a vaginal hysterectomy and anterior repair for prolapse still has issues which preclude trampolines.

Chant de la Mer

No I won’t panic, but I will be prepared for surgery later in life. I’m just incredibly sad that this is very likely in my future since I already do suffer stress incontinence and have since my first baby was born. On the plus side, it hasn’t really worsened and my MIL just went through surgery for bladder prolapse and is doing very well so perhaps things will improve in that specialty by the time I need it done. I am worried that I will need it done earlier in life and that the surgery often needs to be revised after some dozen years so I would need multiple surgeries. But alas it is too late to do anything about those giant babies so I will ignore the issue until it becomes “pressing” Hah!

sdsures

Thank you for being on the planet, DrKitty!

demodocus

part of me is (probably inappropriately) amused by the juxtaposition of obstetric fistual and bullshit. I’ll go have adolescent sniggers over here now.

momofone

And yet, here you are.

MaineJen

“These things did not happen to me personally, therefore I shall conclude that they are ridiculous and untrue. Because my personal experience and preferences should apply to everyone forever.”

Rosalind Dalefield

Pretty much sums her attitude up.

moto_librarian

Try spending a few days with a rectocele, Brooke. See how much fun it is to worry about fecal incontinence. Experience the joy of splinting every single time you have a bowel movement.

You are an asshole.

The Great Queen Spider

It can affect bladder control for sure. I know several women who pee a little every time they sneeze after having kids. Just because it didn’t happen to you doesn’t mean it won’t happen to others. No need to get offended by this either.

Roadstergal

I thought it was a rather nice moment when a comedian we were watching on TV was making a joke about having to yell for her kids while grabbing at her pants with her other hand to sop up the pee (it was well-set-up and well-executed, I do it no justice). Finally, it was being talked about openly as Something That Happens after two kids.

I had to explain the joke to my husband…

ElaineF

Ever since about 7 weeks gestation with my younger one I’ve had to cross my legs every time I cough or sneeze to avoid peeing a little. It happened during the second half of pregnancy with the older one, but went away after I had her. After the younger one, it stuck around. He’s now 2. He was born in 5 pushes and I had zero tearing, so it’s not even like I had a prolonged pushing phase and trauma leading to this issue.

Chi

I’m one of those women too. I had a ‘natural vaginal birth’ with only NOS for pain relief and an episiotomy and now I pee a little when I sneeze. It is embarrassing and uncomfortable and I get really tired of people telling me I need to do more pelvic floor exercises.

But no one tells you that that is a potential consequence of NVB. If they had I might had opted for an elective c-section instead.

sdsures

I pee when I sneeze. I’m on meds for it, and haven’t had kids yet. I have also been known to poop when I sneeze. It happens.

This is why I am demanding an epidural as soon as possible.

Azuran

If you want to avoid increasing your risks of post birth incontinence, you might want to look up maternal request c-section instead. I don’t think an epidural has much effect on post vaginal birth incontinence.

KeeperOfTheBooks

Sad thing is, even without vaginal birth, pregnancy can do a bit of a number on your pelvic floor. (Not, of course, to discount what a vaginal birth can do, either.) I never went into labor with DD, but afterwards found that I’d need to use the bathroom a lot more frequently than before or be seriously uncomfortable. DD’s lucky she’s cute!

sdsures

LOL

Heidi

I know you actually never follow up with any comments you make. You don’t actually want to hear the other side, I suppose afraid you might change your mind. However, I had a 6 lb. 5 oz. baby and had a second degree tear. Doesn’t sound like it’d be so bad. However, I now have scar tissue and I don’t know if sex will ever not have a degree of pain to it.

Megan

“This blog is becoming more ridiculous and predictable every day.”

Well, someone is anyway…

AllieFoyle

For some women it certain does. It did for me. I wish you and that wretched doula discussed here could experience a touch of the pain of obstructed, unmedicated labor, and the years of anguish, shame, and depression that childbirth injury can cause.

Don’t believe it? Here’s Nick Kristof on obstetric fistula, a horrifying childbirth complication affecting women without access to c-sections (and, as he notes, used to be common here too):

It’s very hard to discuss openly, but childbirth injuries left me leaking and, frankly, disfigured and dysfunctional in the most intimate and upsetting way. I consider myself lucky to have been able to have a surgical repair with reasonable success, but there was so much misery — the shame, the pain, the feeling of loss, feeling disgusting– that there were times I didn’t want to continue living.

People like that doula — they pretend they care about women and bodily autonomy, but they don’t care one whit for women like me, don’t even acknowledge that we exist or that our suffering is real.

Roadstergal

“Fistulas used to be common in the West, and there was a fistula hospital in Manhattan on the site of what is now the Waldorf Astoria hotel. But once C-sections became available, they largely disappeared.”

So the drive to reduce C-sections is the drive to increase fistulae…

sdsures

When I went to my GP about it and sked for fecal incontinence pads, he said that he was very sorry but they were ONLY given out in hospitals! GPs had no access to them. He could give me pills for bladder spasms, which have helped a lot, but that was pretty much it. I was 34 and mortified.

I felt so disgusting when I had an accident, although they have been much rarer now that we know I’m lactose intolerant. But we discovered that connection on our own, pretty much by, well, “accident”! My tummy likes Lactofree just fine.

KeeperOfTheBooks

Leaving aside anything else, it seems like that’s epically stupid from a business perspective. I mean (last I checked, at least) companies like making money, yes? And while I imagine there isn’t as big a market for fecal incontinence pads as there are for menstrual pads, there certainly must be *a* market, and I doubt it’s statistically insignificant. So why not make/market/sell them to the general public? What, are people going to OD on them? :p

sdsures

Beats me. 🙁

Rosalind Dalefield

For some women, it absolutely does.

sdsures

Yes, for some women, it can. It’s been scientifically proven that damage to the PC muscles can cause both fecal and urinary incontinence.

sdsures

What’s ridiculous is your refusal to accept scientific reality.

Allie

The only time I felt my autonomy was not respected during my hospital birth was when I requested pain relief and my request was met with “you don’t need it; you can do it.” I feel that I was rational in terms of knowing what I wanted, although the pain made me irrational in the sense that I knew it would all have to be over eventually, but I had absolutely no conception of how that would occur. At the time, I thought it was too late for pain relief for me as I was basically fully dilated by the time I got to the hospital. But I didn’t give birth until 5 hours later (5 hours of pushing), and I learned after that there were pain relief options even at my late stage, but they weren’t even discussed because of course everyone assumed I would want to labour without pain relief although that was never a desire of mine. I had prepared a very brief birth plan that expressed my preference for precautionary IV lines and opiate-based pain relief, but I never gave it to anyone because I didn’t want to burden my health-care providers with any unreasonable demands. I need to be more assertive : /

I had a doula because the service was included with the only slightly woo-ish birth program that I participated in. She was mostly great – she provided literal support in that she held up one side of me while my husband held up the other while I pushed. However, she had no say in terms of giving any medical advice. I think doulas can be helpful if they stick to a role of offering judgment-free support and are not total birth junkies (i.e. they have day jobs, which mine did – I think she did just genuinely enjoy helping people through the birth process, no matter what that might entail, be it full-on home-birth or in-hospital birth with interventions as indicated).

I have never understood what doulas do, except get in the way. L & D nurses and competent nurse midwives can do everything a doula does, and do it better.

MI Dawn

As much as I liked my OB, I would have liked to have a doula during my labors. It would have been nice to have someone additional to lean on, as my husband wasn’t very comforting. The L&D nurses were great but too busy to be with me constantly. And no CNMs when I delivered, either (not that I wouldn’t have been triaged out, anyway, with the pre-eclampsia).

KeeperOfTheBooks

I haven’t had a vaginal birth yet (scheduled CS d/t bad positioning for first kiddo) so take this with a grain of salt.
I ordinarily consider myself a strong person who doesn’t need the help of others. I actually feel more comfortable in a medical setting than I do in a lot of other settings due to my personal background–think extremely dysfunctional family life in which volunteering as a teen at my local hospital was the only bright spot. I love my OB; he’s awesome.
However, being alone and vulnerable and dealing with the unknown terrifies me. DH is a wonderful man, but is absolutely dreadful at emotional support during high-stress times. While I was hospitalized post-CS with DD and freaking out because breastfeeding wasn’t going well, he spent the entire time playing video games and complaining about the sort of food available in the cafeteria. Based on that experience, I can’t expect him to be my primary support person during labor. I’m not even sure he’ll be there; it may work out better for BFF and I to go to the hospital, and he comes down to visit baby once we’re both sorted out.
I am FAR from woo-y; I just want another person there who I know well and trust to not leave me alone if I get scared or overwhelmed, and who won’t blow off my concerns or retreat into gaming when he doesn’t know what to do. L&D nurses are often awesome, but from what I understand, they aren’t going to be sitting next to me for 18 hours of labor. And if I get one who isn’t, or who doesn’t care about the fact that I’m hurting and scared, or who doesn’t call the anesthesiologist because NCB Uber Alles, or who gets an attitude because I’m not willing to try breastfeeding again, I want someone else there to have my back. If I have another CS, I’m cool with that. Episiotomy/instrument extraction/whatever? My OB knows what he’s doing, and doesn’t do that stuff on a whim. (Do any?) I just don’t want to be alone when I’m in pain. Does that make sense? And if my awesome BFF couldn’t make the long-ish drive to be with me, I’d hire the non-wooiest doula I could find to do the same thing.

ElaineF

A not particularly crunchy friend of mine hired a doula with her first for kind of similar reasons–she didn’t think her otherwise lovely husband would be all that great for labor support, and didn’t want to take the chance that she couldn’t get support she needed from him and didn’t have another person in her corner.

Erin

One of my very NCB infested friends recommended one to me (she thinks my reasons for no more children are based on fear and thus not good enough). As far as I can tell she essentially cheerleads and reminds you to hypnobirth. As part of the package you get a birth related colouring book (there is a c-section one) and post-natal support which can include hot meals, loading the dishwasher etc.

I’d take the colouring book and the food but a bit iffy about the rest. Anyway i will be meeting her as said “friend” signed me up for her “dealing with Birth Trauma workshop”.

And yes, I know I need some new “normal” friends.

Dr Kitty

Erin, I hope you get something worthwhile out of it, but I think your realistic skepticism is warranted.

Are you sure you really want to go to this workshop?

Erin

I’m working on the principle that they’re unlikely to be able to brainwash me in 5 hours. Plus I still wake up screaming courtesy of nightmares based around my son’s arrival far too often so if there is even a one percent chance it can help, I’m tempted to take it.

I need an improvement or a better “lying face” before my next psychiatrist appointment, otherwise he’s re-referring me to a psychologist again and yes, there is a degree of clutching at straws involved.

Dr Kitty

A different psychologist though, right?

All I’m going to say is that if you need to leave, stuff the five hours and just leave.

Erin

I already have a mental checklist, any mention of re-birth, any attempt to blame a “cascade of interventions” or the words “healing” and “birth” being used in any other way than to discuss healing from a birth you’ve already had and I’m off for some retail therapy instead.

Yes, a different psychologist. Although given the issue lies with me and not the psychologist, not sure it matters.

Chi

The issues may be yours. But if professional therapy is going to have any chance at working for you, you need to feel comfortable with the therapist.

So trying different people isn’t necessarily a bad thing. I hope it works for you.

Zornorph

I read that whole article. Oh, Lord, that is one vile woman with some serious issues. Even other doulas don’t seem to like her.

Jordan Neely

birth plan is an oxymoron, because you have no idea how your body might react to labor and delivery. these women should be grateful for pain relief and access to a c section. I know that I was.

Mad Hatter

That’s why I never made a birth plan. Just talked over my preferences with my doctor with the understanding that me and my baby being safe and healthy was most important. And I got what I wanted, a safe delivery and healthy, beautiful baby!

I made a snarky, anti-woo birth plan. And ended up with a woo-y nurse who was a bitch to me and inserted my catheter so aggressively that I felt every contraction in my bladder.

The Great Queen Spider

Oh no. What a vile woman.

Caylynn

I wish I could get appropriate pain relief during menstruation. Unfortunately, I’m one of the unlucky ladies with severe endometriosis, and even with painkillers, end up in the fetal position for a day or two every cycle. I’ve had two laparoscopies for it, but the pain persists. Tried continuous BCPs but my body insists on having a period every couple of months, even when continuing to take the hormones. I’ve tried many other treatments. Sadly, doctors around here won’t prescribe narcotics for endo pain (scared of making us addicts, I suppose), and that’s the only thing that seems to help the pain. Toradol just takes the edge off, but still leaves me unable to function.

MichelleJo

Can’t be of much help, but I can sympathize. Menstruation for me used to mean attacks of up to ten hours of such agonizing pain that I spent them curled up in bed, rocking back and forth, sobbing from pain. Pain on that level with no explanation, would have undoubtedly led me to the ER where it would have been investigated for a cause and treated if a treatable cause was found. But it was ‘just’ period pain, so it didn’t matter. I wish pain was taken more seriously in itself. Thankfully, those days are in the past, ever since my first birth. But having been through birth without painkillers, I can say that I suffered from pain of a magnitude that easily competes with labor, every single month. I really hope you find a solution.

Don’t you know that women tolerate pain better than men? When in the ER in absolute agony with my osteoarthritic hip, the amounts and kind of pain relief were laughable, especially considering that I weigh nearly 100 kg. A man of that weight would have received about twice that dosage. When I complained I was told that “women need less” pain relief than men. So I began screaming.

MI Dawn

Holy crap! That’s disgusting. If I ever had someone say that to me, I’d scream, too. Fortunately, the one time I was in the ER in agony (ectopic pregnancy), once they knew what was going on, I got good drugs.

Dr Kitty

I’m very little, and while the merest whiff of a benzodiaepine or propofol and I’m out for the count, I have a very high tolerance for morphine.
Biology is weird.

Everyone usually thinks the doses of morphine in my old notes are typos (“It says here you got a bolus of 26mg IV morphine! Surely it means 2.6mg!”) and they are terrified that I’m going to stop breathing if they give me the amount I actually need.

Therefore I am used to asserting myself strongly in order to get adequate analgesia.

Thankfully, I’ve never been accused of drug seeking behaviour, because I’ve always either been acutely postoperative or about to go into emergency surgery when I’ve been asking for MOAR MORPHINE!

Charybdis

I have a disgusting tolerance for opioid pain meds, thanks to a history of migraines (4 days! Each migraine attack! Triptans don’t work and I had bad side effects from them! Fun times) and the redhead tolerance to pain and anesthetic. When I have surgery, it takes so much to put me under and keep me under that I wind up violently ill (mostly non-stop vomiting for hours) whilst in recovery. I can take two 2 Lortab 10/325’s and keep on trucking. I also have an insanely high pain tolerance, thanks again to the redheadedness.

So if I am having a migraine attack that is bad enough for me to ask DH to take me to the ER, he KNOWS IT IS REALLY, REALLY BAD. We then have to do the dance of “here’s some IV phenergan, that can really help a migraine” followed by “here’s some IM Imitrex, that will stop a migraine” and then by “let’s try some toradol” and finally wind up with the demerol or fentanyl or morphine, whatever “big gun” pain med they are willing to try.

I hate that you can’t just tell them what works, because then you are labeled a drug seeker and that they feel like they need to question the level of pain….’does it really hurt that much?” “Let’s try a number of ineffective meds, just so we can check off our pain med escalation boxes. Why can’t they just start with the bigger guns?

It’s like our pain doesn’t matter, or that we are being whiny, weak and a pain in their collective asses if we try to get the relief we need.

Chi

I had a migraine last month and was complaining that I’m out of codeine tablets (those usually quieten a migraine down to a tolerable level). I mentioned to hubby that if all else failed I had some tramadol so could take that, even though I usually feel hungover the next day if I do.

He was like ‘you’re far too quick to go to opiates’.

Never mind the fact that I’d already downed paracetamol and the migraine had laughed at that. I’m not really supposed to take ibruprofen as I have a history of stomach ulcers. And I know for a fact that once a migraine is in full swing the only thing that will give me any relief is opiates.

But I was soooo pissed at my husband for that off-hand comment. It’s like, ‘you’re not experiencing this pain. I’d bet good money that if you were, you’d be screaming for opiates too’.

Women are considered the ‘weaker’ sex and yet we’re supposed to tolerate greater amounts of pain than men, quietly and sedately? How does that even work?

Empliau

Me too – triptans make me very ill (my doctor wrote in my chart that I’m allergic since the history of my interactions with them is a long and complicated story, but basically he doesn’t want me anywhere near them). And with migraines, as with childbirth, busybodies everywhere have the answer: Elimination diet! Chiro! Acupuncture! and, of course, Imitrex! Never mind that I’ve been dealing with these for fifty years, have a good sense of what works and what doesn’t, and have used opioids sparingly for decades without dependence or addiction. With the new crackdowns I’m concerned that one of the medications that help will be very hard to get. Seriously, when I gave birth it was a walk in the park compared to migraine, in that it will end sometime. (And there is a reward at the end, a lovely baby.) With migraine, one never knows …

Charybdis

Tell me about it. It is already a pain in the ass to deal with now: you have to physically go to the doctor’s office to pick up a hard copy prescription for the pain meds because they can’t put refills on a prescription nor can they call in a refill for you, then you have to show your ID to get the prescription filled, the meds are in a time lock safe so you really can’t wait for them, you have to drop off and come back awhile later, then you have to show your ID when you pick up the prescription and they also scan it before you get the prescription.

And it will only get worse because, you know, somehow those of us with a legitimate need for the potent opioids are somehow causing the uptick in prescription opioid abuse and responsible for the people who OD. *eyerolls until they stick*

Roadstergal

“Thankfully, those days are in the past, ever since my first birth”

I remember my dad telling me that my mom had fierce, debilitating period pain just like me, and it didn’t go away until her first baby.

Fortunately, I’m one of the lucky ones who responds well to hormonal birth control. I hope we keep working on better and better ways to take control of our bodies.

Dr Kitty

Have you seen a pain specialist?

My endometriosis only responds to my ovaries being switched off.
For me, pregnancy works, breast feeding works and Nexplanon works. Mirena worked while I wasn’t ovulating, but that only lasted for 18 months or so.

But then they’d be actual reproductive rights activists instead of biological essentialist fascists… They don’t need to recommend C-sections and epidurals, merely accept that another woman’s acceptance of C-sections and epidurals in no way infringes upon her own right to refuse intervention in order to exercise her own autonomy. That’s the bit they can’t accept, the bit where other women make different choices, and those choices are also completely valid.

Rosalind Dalefield

I remember one of my OBGYNs said to me ‘If a woman can demand the right to a home birth when I don’t think it’s a good idea, she should also be able to demand the right to a C-section even when I don’t think it’s indicated.’ Oddly enough that OBGYN was a man!

Gia Rebecca

So does that same doctor think that if someone has the right to refuse treatment when doing so endangers their health, then other people should have the right to have more morphine than indicated if in pain?

Azuran

I find their complaint about bodily autonomy and medical care completely ridiculous. Birth is still a medical intervention. Sure, women have to be informed of all possibilities and be allowed to make some choices, but it has limits, and it has nothing to do with violence towards women. It’s because of medical standard and proper medical care.

When my mom had to undergo surgery for a brain aneurysm. She didn’t get to chose at which hospital it would be, nor which doctor would do the surgery, nor the date it would happen. She had no say in whatever drugs was used in the anaesthesia. The anaesthetist gave whatever he judged to be needed for such a precise surgery, nothing else was ever considered as a possibility. The neurosurgeon said there was 2 ways to do the surgery, and that he would decide on which one he would do once he was ‘in there’ It wasn’t up to her do decide which technique she prefers. She was fasted before the surgery, she was hungry, but still had to do it. After the surgery she had to stay overnight in the ICU with her vitals being checked every 15 minutes all night long.

All of those things have nothing to do with bodily autonomy. She needed medical treatment and she got it. You can’t go and personalize medical care with rainbows and unicorn. There are standards that have to be respected, some things must be done for your own sake, even if you don’t like them. Same goes with birth. Doctors are not trying to be mean or trying to dominate you. They are trying to do what their medical training and experience is telling them is the best course of action.

No in most cases of medical care that are not urgent/emergent, the patient is given the right to make choices with respect to treatment – as an example, the Jehovah’s are free to decline the use of blood products even when those products are the best chance for the best outcome.

Azuran

In a general sense. Like my mom had the choice between having the operation or not having it­ after being told the risk or benefits of both. But all the medical things where left to the specialist. You have the right to refuse a blood transfusion, with the understanding that you might die. But the doctor will still recommend it even if you are a Jehovah’s witness and make sure you understand the consequences or refusing. A doctor recommending a transfusing to a Jehovah’s witness is not a lack of respect or an attack on his bodily autonomy. It’s just the doctor recommending what’s best. The patient then has the right to refuse.
Same thing, a doctor asking you if you want an epidural, or recommending a c-section is not obstetric violence against women or an attack on your autonomy. It’s just a doctor doing his job.

allie

As Azuran has pointed out, capable adults are free to accept or refuse even life-saving treatment based on their own values, wishes, or beliefs, but once they have provide informed consent to a course of treatment, doctors must perform that treatment within the parameters of an objectively based standard of care. I have always argued, however, that obstetric care is qualitatively different that other medical contexts because doctors owe a duty to both patients – the mother and the fetus. That can create a conflict of interest when the mother’s choices are at odds with the best interests of the fetus. How best to resolve that conflict, I know not, but I suspect the answer lies in open and honest communication between women and their health care providers and a reasoned decision by women, who must weigh what they want against what is realistic in their particular circumstances.

Rosalind Dalefield

I think another difference is that most fields of medicine do not suffer from so much criticism and outright falsehood from people outside the profession.

Chi

Except maybe oncology.

Rosalind Dalefield

Oh, good point. Yes, oncology suffers from huge amounts of misinformation from outside the profession, too.

OT but definitely not ‘Off Site’, my ‘baby’ sister, 17 years my junior, just gave me the thrilling news that she is soon to become a mother. And what better gift could I give her, than going to Amazon, and pre-ordering Push Back. With a note attached “Dear C, Perfect gift for your lovely news. I just want you to enjoy your first baby when s/he finally arrives, because you deserve to. It’s what I wish I could have read 18 years ago! Love You, M.” Thank you Dr Amy!!

sdsures

Fantastic news!

MichelleJo

I think so too :-). But my sister is bowled over by everyone’s excitement. We are 11 siblings, and she is the youngest. And, we all have kids. So she thought we’d take it in our stride, congratulate her – another niece of nephew (lost count which number) – and say how happy we were for her. But it wasn’t like that at all. All ten of us were so genuinely thrilled and overcome, some to the point of tears. Because for her it’s her first, and a sister is a sister. Believe me, I don’t have close to 11 kids, goodness knows how my mother did it. But I can say that having so many sisters (3) and brothers (7) is probably the best thing she ever did for me. Unlike what you would think, that a smaller family would be closer, I feel like each one them is my only sibling. There’s nothing we wouldn’t do for each other. And when we get together, heaven help my parents.. seven men in their thirties behaving like naughty little boys, and us girls laughing till we cry. Oh the fun of it!

sdsures

Eleven?! Wow – I mean, that’s great, but let me recover from the shock a bit.

I wish I was as close to my (only sibling) sister, but unfortunately not. Even before I moved from Canada to the UK, things have always been tense between us for a variety of reasons, one of which still bothers me a lot 16 years after the fact. I actually blurted it out to complete (female) strangers yesterday on Facebook, and I apologized profusely for dumping on them. But they said I wasn’t nuts or holding a grudge, as I fear both my mother and sister would inevitably say if I told either of them. The situation that happened caused me to get triggered whenever similar situations crop up. 🙁 Maybe I need therapy?

MichelleJo

I would do what it takes to make up. I don’t think therapy is such a bad idea – maybe just one session which can help you see the situation clearly and the therapist might point out things you hadn’t considered. It may mean swallowing your pride, or agreeing that you were at fault when you weren’t. I don’t know what the issue is, and I don’t know that I would do any better than you. But blood is thicker than water. Yes you can have great supportive friends or a great spouse, but a family you get along with is a treasure. Underneath any resentment, there’s a link that can’t be severed.

Gatita

Very interesting comment from the site. Doesn’t end the way you think it will.

In “Confessions of a Radical Doula,” Elisa Albert boldly proclaims that obstetric violence is alive and well in hospital births, and that doula trainings are woefully unprepared to teach doulas what they really need to know as protectors of the birth space. She describes a doula training where the focus is on comfort measures, active listening, and natural childbirth, and doulas leave without any understanding of their place as agents of social change.

Doula Trainings International was created to be an alternative to this passive training model. DTI doulas are advocates, they are culturally competent, and they refuse to be wallflowers when confronted with violence and abuse.

It is worrisome, however, that this article conflates medical interventions in general with abuse and lack of consent. Birthing people have the right to choose interventions that are medically necessary or elective, anything less is limiting their agency. A doula’s role is to advocate for the birthing person’s autonomy, not for natural childbirth or the least amount of interventions. Birth trauma can happen in any type of birth situation where the birthing person is not heard, supported, and respected. It is just as “radical,” if not more, to be a birth activist that leaves your agenda at the door and is committed to your client’s autonomy.

While reading the article, I was horrified by the author’s cavalier views of patient rights. She implies through the whole article that any woman who doesn’t conform to the NCB mold is brainwashed by society and therefore those women’s wishes can be ignored.

She’s as extreme as the “evil OB’s” that she abhors and completely unaware of the parallels between her and her arch-enemies.

LaMont

It’s really disturbing to see the idea of supporting women who are being abused, even if they don’t yet recognize the abuse due to their isolation or dependence on their abuser, perverted in this way. There may be instances where women won’t name or recognize abuse, but post-birth women who “aren’t outraged” don’t fall into that category… this is absurd and atrocious.

Deborah

Much better compared to Elisa Albert’s view but still some murky areas.
“Birthing people have the right to choose interventions which are medically necessary or elective”
Yes they do but do they always understand when and why an intervention is medically necessary? It depends on how far up the woo ladder they are. If they are only one or two rungs up they will probably be more amenable to interventions. If midway up they will be declining most things. And if they are at the top they are very difficult to work with and the doula will be doing her best and dangerous work.

Cartman36

They would also support a women’s right to choose to EBF, supplement, or strictly formula feed.

Rosalind Dalefield

…and to not have her breasts or nipples grabbed by nurses or midwives without her permission.

Sean Jungian

Very well said! I’m glad you took this one on after reading about this hippie-dippy baloney in the comments yesterday.

Obstetric ‘violence’ indeed!

LibrarianSarah

Can I just add that it is exponentially shitty to say that “obstetric violence is the last acceptable form of violence against women” when it is obvious that good old fashioned man hitting/threatening violence against women is pretty damned acceptable to a sizable part of the population.

We live in a world where a major sports organization treats players abusing animals more seriously than players abusing their wives, another sports organization on the other side of the world is looking forward to getting one of their star players back once he finishes serving his time for rape, and numerous women are run out over their own homes for making or having an opinion on video games. To say anything is the “last acceptable form of violence against women is laughable.

Roadstergal

Most excellent point.

Gatita

So offensive!

sdsures

Recently, I watched the movie and read the book “The Stoning of Soraya M.” which is based on a true story – took place in a backwoods Iranian town in the 1980s. Completely false allegations of adultery were set up deliberately and made against Soraya, so her cheating and abusive husband could get grounds for a divorce to marry a 14-year old girl.

Wonderfully acted movie. Disturbing, obviously, but that’s the point. Soraya’s story needed to be told, and the journalist smuggled the interview tapes (with Soraya’s aunt) out to the outside world. The stoning scene was awful to watch, but reading about how the filmmakers accomplished it with clever camera work and mannequins helped.

Really, I encourage you (anyone) to watch it. This has both Farsi/Persian and English subtitles. They overlap a bit, but once you get the hang of it, you can just focus on the English. https://www.youtube.com/watch?v=ufx4JWpMboQ

Gatita

I don’t want to like this but I appreciate you posting the link. Gives you a lot of perspective on how much work we need to do on human rights for women.

sdsures

It’s OK – I know what you mean. 🙂 There are interviews on Youtube with the main actresses in English, which might be easier to deal with, since they’re a “making of” sort of add-on.

Cartman36

And female genital mutilation which is sadly still happening all over the world

I just Googled breast ironing. That just … It’s cruel, and it doesn’t even make any sense. As if there needed to be just one more way to punish girls for being born female.

sdsures

Ugh, should I NOT google that?

Too late.

Who?

Another death of a woman here overnight, apparently at the hands of her partner, in what senior police and paramedics describe as one of the most confronting crime scenes they had ever attended.

But yeah, birthing in safety, with minimal pain, in a nice clean hospital is totally the last bastion of acceptable violence against women.

Mishimoo

Turns out that was only a few km away from me; that poor woman! (And emergency personnel) 🙁

Who?

Horrible. What a miserably wretched and terrifying way to die, and imagine what she’s had to deal with in the run up.

On a cheerier note, enjoy what’s left of the school holidays!

Mishimoo

It’s heartbreaking, and I am not looking forward to my m-i-l’s speculation, especially since she usually goes with the “I wonder what she did to deserve it…” bullshit. No one deserves that!!

One week left, and we’re going to chill out at home mostly. My husband had time off, so we’ve spent the last week exploring and I think the kids are tired of the car.

Who?

Quite. You’ll remember when, a couple of years ago, a woman killed her teenage daughter then threw herself off the bridge, with her son still in the car?

One of my less than charming work colleagues at the time was heard speculating, at top volume, what the girl had done to deserve it. There is really nothing to say to that kind of thinking, except perhaps speculate what they put up with-or dish out-at home.

Sounds like a really nice week-no routine, nowhere to be, is great.

Mishimoo

Ugh, yes. I remember that for much the same reason. I ended up losing my patience over the gossiping and yelling for a bit. It didn’t make much difference, but I sure felt better. That poor girl deserved better than that, as did her brother.

sdsures

MILs can be difficult beasties. So can moms, actually.

KeeperOfTheBooks

Quite.
Since long before I met DH, I was a moderately rabid baseball fan. DH is a rabid (no qualifiers 😉 ) American football fan. We both have a running sarcastic commentary, though, when Insert Sports Star Name Here gets a year-long suspension/lifetime ban for using some sort of PED, but is suspended all of a game, if that, for driving under the influence/beating his wife/kid/girlfriend/etc. And yet it seems to occur to no higher-up in these sports organizations just how screwed-up these priorities are, or even how it appears. Beat your girlfriend? Sure, we don’t mind if you represent us on the field! Take some questionable hormones or steroids? OMGELEVENTY you’re a disgrace to the sport, begone, Satan!
*snarls incomprehensibly*
I’d like to think we aren’t alone in fandom in this, and that at some point there’ll be some sort of reckoning, but I may be overly optimistic.

Cody

I’m a doula and I help women to get epidural and c-sections. Many of us do. I think most of us are moderate and are also responsible professionals. There is a vocal minority that is about natural birth at any cost.

The Bofa on the Sofa

Thanks Cody. I have a question – what do you and your friends do about that vocal minority to quell their irresponsible behavior? Do other doulas ever call them out and tell them to knock it off?

Cody

Hmmm. I just replied to this and it disappeared. Sorry if I end up replying to this twice.

It went something like this.

We absolutely do. Ive been in my share of nasty arguments. I live in a fairly affluent area and the working doulas tend to be moderate. Sometimes there are new doulas who think they’re going to change the system or something but they don’t usually last long.

AirPlant

My husband has a doula friend from nursing school who is just the WORST. They had to observe a section together and she legit started crying. She said that she just couldn’t handle seeing a woman’s birth taken away from her.
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So really, if you have a list of sane doulas a copy would be just amazing.

momofone

That’s always confused me with the NCB crowd. The woman’s birth was years ago. It’s the BABY’s birth.

Cody

That’s true, but it is a very memorable experience for women and it can be very scary. I’m speaking about birth in general terms here, and not commenting specifically about c-section.

momofone

Sure it is, both memorable and scary. I’m just commenting on the idea that it’s “my” birth, and that as such, somehow I’m entitled for it to go the way “I” choose, as opposed to my child’s birth, and something that may in some/many/possibly all ways be beyond my control.

Cody

Ya but things happen to mom’s body too. It isn’t one way or the other. I think the entire NCB movement started in response to a framework that was extremely sexist and really discounted a woman’s say in the process, and to say “it’s all about the baby” doesn’t ring true for a lot of women. That includes women who want a c-section and are told no. That includes women who want an epidural and are told no. A healthy baby is obviously the most important part, but women deserve to be respected, and have their wishes taken into consideration when all is going well. Maybe women don’t get a great experience most of the time, but in a perfect world they would be “entitled” for birth to go the way they want and you can’t blame them for aspiring to that. I work with a lot of women with past trauma, and for that group of women, birth is very much about them.

Jenny

And women who are talked out of a c-section by the promise of an epidural, but then denied pain relief by the nurse who happens to be on duty when they deliver.

Bombshellrisa

Happened to me. And because I was progressing well and found a measure of comfort in moaning and tuning out, the nurse was not going to call for any epidural no matter how much I was hurting.

Cody

Not okay. That sucks and I’m sorry that happened to you.

KeeperOfTheBooks

That is absolutely horrifying, and completely inexcusable. I’m so sorry.

Bombshellrisa

I have had time to reflect on it and some of it goes back to my upbringing. Trying to speak up for myself and being afraid I was being too demanding or “dramatic” played into what happened. I was trying to be as calm as possible for my husband too. He had the great misfortune to have been from a home birthing family and the first birth he saw scared him greatly (he was in first grade at the time).

KeeperOfTheBooks

That makes perfect sense, actually. I have a very similar script in my head–don’t make more trouble for people, don’t bother people with your pain, etc. While I can recognize it, I’m not sure that labor is the place I want to be worried about breaking out of that mold, y’know? Which is why my instructions to my BFF/support person for this next kiddo consist mostly of “if I say the words ‘epidural’ or ‘pain relief’, find me someone who’ll get me whichever yesterday, and no nonsense.” (I’m giving birth in a very major hospital, so it’s not like there’s a shortage of anesthesiologists, etc.) I’m not sure if I’ll go for an epidural or not, and don’t plan on deciding ’til I’m actually in labor, but if I want one I don’t want some fool of a nurse trying to put it off.
Fortunately, DH’s views on childbirth were mostly formed by reading, of all things, Queen Victoria’s letters to her daughters on the subject (history nerd, to say the least) and so his views pretty much consist of “pain relief: awesome! Why the hell wouldn’t you want it?”

EmbraceYourInnerCrone

I used to be like that, don’t make noise, trouble, etc for other people. Some how the older I get the few worries I have about that. I have become the crotchety old lady(I am only in my fifties but if crotchety works, cool!) It got me migraine meds finally, after putting up with the pain for decades.

Bombshellrisa

Does your healthcare provider give out birth plans and use part of an appointment to talk about what you have written? My OB practice did this when I had my son. Any way to talk to your OB about it and get it charted that your request for pain control is real and any nurse who tries to be a birth keeper or gate keeper of the epidural will have their pic taken along with their name written down and will be reported to the nurse manager of L&D, the house superviser and HR at the hospital.

KeeperOfTheBooks

Good point. Birth plans for my OB are more a “if you want one, do one, if not, no worries” thing. Last time around, I brought one in at my 30-something week appointment, he glanced over it, agreed to nearly all of it (barring, of course, emergencies), and signed off on it. I should probably knock one together this time, too, and that belongs on there. In thinking about it, I am amused by how much shorter this second one will be than the first one. Heh.
It’ll probably be something like “If time allows, please explain to me exactly what’s going on, I haven’t done this before so suggestions welcome, I won’t know til I’m in labor if I want an epidural or not, but if I ask for one, get it immediately, I’m not breastfeeding, here’s religious info if baby or I are in danger of death.”
I can’t imagine his having a problem with that, and he tends to get what he wants in that hospital, so having him sign off on a plan that includes information like that about anesthesia is a really good idea.

Bombshellrisa

That sounds like a very good plan. It’s important for your care providers to know what you would like.
I am serious about the picture taking and reporting though, and you should apply that to pushy LCs too.

KeeperOfTheBooks

The LC thing is a point I forgot in that post–I’m going to specifically request not to see any. I’m not planning on breastfeeding anyway, and based on my last experience at that hospital, their LCs are completely nuts. If one comes in anyway, I’ll mention once and politely that I’m not interested, thanks. (They may well have not seen my request, no need to be nasty over a misunderstanding.) If they say anything beyond “no problem, sorry for the mixup, have a nice day and congrats,” it’s picture-and-reporting time.

Bombshellrisa

Oh yeah, if they are pleasant and leave you alone no need to get upset. I was really lucky that the LCs I saw were really kind. I did mention them by name because I wanted to make sure that they were recognized for the good work they were doing. Plus, any LC who rolls her eyes when saying the words “baby friendly” is ok by me.

Sean Jungian

I’m not sure why birth plans get such a bad rap, probably because they’ve been hijacked by NCBers to be kind of confrontational? In any case, the hospital and my OB’s office asked me to do one way back in 2001 and I think basically they just wanted to know if I was adamant about a non-medicated vaginal birth (I was NOT) and just how much pain management I was looking for (ALL the pain management, thank you).

I expressed that I did expect some pain but that by no means did I want to suffer as long as it wouldn’t hurt the baby. I had demerol I believe (IV) and I did receive an epidural. I actually had no question that I’d have an epidural, there was no way I was even going to attempt birth without one.

Monkey Professor for a Head

I was told for hours that I wasn’t in active labour and couldn’t have pain relief – I was in severe pain from back labour but I think that because I wasn’t screaming I wasn’t believed. When they finally reexamined me (about 12 hours after the initial cervical check) I was at 7cm. Luckily I got a wonderful epidural then and the last few hours of labour were rather pleasant.

Rosalind Dalefield

I got told that I wasn’t in labour *at all* and should go to sleep, until I was 6 cm, with my first labour 🙁

AirPlant

I actually agree wholeheartedly. Even if the goal of childbirth is a healthy child, the woman still has to live through it and the woman matters. In the context of a hospital there are so many safe ways to give birth, there is nothing wrong with wanting one that fits with your outlook, whatever that is. I really like that sane and competent doulas exist to guide women through their options and do the emotional work that medical professionals might not be equipped for.

momofone

I’m definitely not saying “it’s all about the baby,” and I’m 100% in support of women’s wishes being respected. In a perfect world, of course all would go well and according to plan, but of course it isn’t perfect, and for me, anyway, it also isn’t all about what I want. I also work with lots of people who have experienced trauma, albeit in a different capacity, and I understand that people are affected by their experiences. My comments are directly related to the people who do see it as an event to be staged, and “theirs.”

Jenny

It may be a very memorable experience for some, or even most, women. However, some of us just want to have a baby. We don’t want some sort of mystical birthing experience, we just want the baby.

We should be allowed to have the quickest and most painfree birth possible, if that’s what we want, rather than being forced into someone else’s idealized version of the “experience”.

Cody

I agree completely.

Sean Jungian

This was me. I just wanted it to be done with so I could get to the good part – the baby.

EmbraceYourInnerCrone

I wanted the baby, but for the baby’s birth I would have liked a teleporter, darn you Star Trek, why do we not have teleporters yet?!

Sean Jungian

That would have been even more than ideal, as in the last months of pregnancy I often said that I felt like a spaceship piloted by an alien.

Rosalind Dalefield

I would have liked to have been in a coma from before labour started, and woken up when it was all over and been handed the baby.

Allie

If the stork was an option, I would have signed up. Just so long as he didn’t get drunk and bring me Bugs Bunny, like that poor gorilla mother : )

yentavegan

Sometimes when the influence of the woo crowd creeps into my thought process and I start to think that perhaps Dr. Amy is meeen and that Dr.Amy is undermining women’s autonomy I think about a photo essay I saw on Hurt by Homebirth where the mother was sitting on an exercise ball having her hair braided in order to get her mind off her pain..all the while her infant was dying inside her and that pain was not supposed to be ignored

Gatita

That is a heart-wrenching image.

Roadstergal

That’s chilling. 🙁

IMO, pain is a low-fidelity analog-ish ‘something is wrong’ signal for the body. If you’re going to ignore it, you’d better have some sort of way of determining that there is indeed nothing wrong… like the monitoring you get in a hospital.

A hospital birth with epidural and monitoring can be viewed as an approach to remove the ‘pain’ signal and turn it into a set of more specific assessments…

AirPlant

I feel like our culture puts a lot of weirdness on the idea of being nice. For women niceness is almost mandatory, but it doesn’t often seem to be so much connected with kindness as it is connected with being well liked.
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Since the NCB crowd is never going to like Dr. Amy what with her being a colossal buzzkill, the easiest thing to call her is mean. I personally think of the song “Last Midnight” from Into the Woods when they start in with that nonsense.

Roadstergal

“You’re not good, you’re not bad, you’re just _nice_…”

“I’m not good, I’m not nice, I’m just _right_…”

AirPlant

I personally like the bit where she (rightly) points out that all the protagonists are liars and thieves despite being so nice… Actually seems pretty applicable.

mythsayer

I had a tummy tuck and thigh lift. I had gastric bypass (about 1% risk of death or serious injury back when I had it…far higher than c-section risk).

I was able to choose a maternal request c-section and I loved it. If I’d had my baby at the American hospital instead of the Japanese hospital, they’d never have allowed it.

No one has harassed me about my tummy tuck or gastric bypass. What’s the difference between those and a c-section? My opinion is if you can choose a homebirth and risk damage to the baby, I can surely request a c-section.

Rosalind Dalefield

Which is exactly what one of my OBGYNs said to me, and he was head of Obstetrics and Gynecology for the whole of my country’s capital city.

Madtowngirl

A little off topic, but relevant to this blog: a woman I’m friends with on Facebook just had her third baby. Her pictures are up, and there are the usual congratulatory comments, with one glaring exception.

“Hospital or home birth?”

She is obviously in a hospital bed in the pictures. This commenter was making an attempt to make her feel guilty about birthing in a hospital. Unreal.

mostlyclueless

Although since such a huge proportion of home births fail and require transfer to the hospital, I never assume that a birth that ends in the hospital was intended to be there!

Gatita

What a completely assholish statement to make. That’s what the Facebook block button was made for.

Rosalind Dalefield

I’d be tempted to reply simply ‘Yes’.

Manabanana

I used to apprentice with a midwife, and am now an RN and student nurse-midwife.

The idea that a woman could not request a cesarean – for what ever reason – never sat right with me. Elective surgeries are offered to people in the US all the time and for all sorts of reasons. To me, it seemed that a cesearean would be no different. There are risks to surgery – all surgery – and everyone undergoing surgery – particularly electively – should be informed of those risks.

But I never understood why we (when I was apprenticing and being indoctrinated by the NCB crowd) would actively dissuade women from c-sections if that is what they wanted. The fear-mongering around cesareans is insane. We had to tell them it was the worst way to give birth, that it would eff up their bodies, that they would be at risk of dying from the cesearean, and that the baby would be at risk of dying or being injuried, that the breastfeeding relationship would be effed up, and the baby wouldn’t get the proper microbiome- and etc etc etc.

I support women who want a cesarean, or who want a natural birth, or who want an epidural, or who start out wanting a natural birth, but then want an epidural, or the women who want epidurals but come in crowning, and we work together and have a baby. I feel good about being able to help women have their babies – and on their terms – and to work with what labor they’re given. All of it. No one should be manipulated to suit someone else’s agenda in labor. I’m happy to be the nurse at a waterbirth – and I’m happy to be the nurse at a cesarean birth. This feels much more balanced and respectful than dictating to women how they should give birth.

I never really fit into that NCB crowd. Because zealotry and righteousness were never my bag.

Daleth

We had to tell them it was the worst way to give birth, that it would
eff up their bodies, that they would be at risk of dying from the
cesearean, and that the baby would be at risk of dying or being
injuried, that the breastfeeding relationship would be effed up, and the
baby wouldn’t get the proper microbiome- and etc

What’s so outrageous about that is that not only were they teaching you to disrespect women’s right to bodily autonomy (and also to set women up to be scared, traumatized and worried to death if they ended up having to get an emergency CS), what they were telling you to say IS NOT EVEN FRIGGING TRUE!!!! Seriously, they were teaching you to lie to the women in your care! That’s just appalling.

Babies are actually SAFER being born via CS than via VB, because all the things that can go wrong in VB–shoulder dystocia and every other form of cord compression, plus brachial plexus palsy–are simply no longer risks at all.

And it doesn’t eff up women’s bodies any more than VB does. It just leaves you with a scar. It CAN’T leave you with fecal incontinence, unlike a VB.

And it has no impact on “the breastfeeding relationship.” The people who believe it does are the same ones who believe that even one bottle of formula or the use of a pacifier will ruin the baby for breastfeeding. Um, no.

As for the microbiome, the only studies on that are teeny-tiny (like 30-40 kids) and they do NOT conclude that anything is wrong with CS kids’ microbiomes or that any health problems result. And even if they did, what mother wouldn’t rather have a problem you can fix with probiotics than a problem (such as brain damage or death) that you can’t fix with anything on earth?!

FEDUP MD

You mean like my kids, who each breastfed, for 10 and 14 months without formula, despite the fact that they needed c sections and a single bottle of formula each after birth, and loved pacifiers with a passion (my 2 year old is still obsessed). I guess they don’t exist.

momofone

I have one of those nonexistent kids too. C-section, formula in the hospital, pacifier from birth, formula even the first few days home, and breastfed for 21 months.

Rosalind Dalefield

A different microbiome does not mean an inferior microbiome, and anyway the microbiome is incredibly ‘plastic’.

Daleth

Right! Throw some yogurt down your gullet and you’re on your way to a changed microbiome.

Rosalind Dalefield

Excellent example. Thank you!

sdsures

The “microbiome” woo has resurfaced recently here in the UK. I know I will need a CS, and I much prefer to have one because I completely understand the medical reasons for it. I’d be insane to insist on a VB. So when I read this article from the BBC, it upset me a lot. Nobody is sticking Q-tips in me, all right??? NOBODY!!

I’m a survivor of sexual trauma and I have vaginismus, so anyone messing about with my vagina or urinary tract, even if they are my doctors, can give me PTSD flashbacks (I freaked out once when I was having a kidney stone removed, and the nurse just barked at me to “shut up”.)

I followed the link and read the dumb article by the vagina obsessed community, but rolling through the headlines below the article, I clicked on one which proved that are still plenty sane people out there. http://www.bbc.com/news/health-20891997

Daleth

Oh how revolting. You may want to tell your care providers up front, when you’re planning the c-section (and again when you go in for it), that you’re not doing that and they’re not to q-tip you AT ALL.

For me, not having strangers staring at and interfering with my vag was a major perk of having a CS.

sdsures

I hate the phrase “fall pregnant”. Maybe it’s because I’m Canadian, and we simply don’t use it much, even though I’ve been living in the UK for over 8 years now.

Is “Bumpology” any good? I once had a look at “Up the Duff” (different author, library book) because I was tickled to death by the title. I think getting that one might be a good idea.

Amy M

I could have elected to have a Csection when I walked into the hospital in labor. My OB was there and she offered it. I declined, because I was very scared of recovering from surgery while trying to care for newborn twins. (Of course I would have agreed to it at any point during labor, if a doctor thought it was needed.) At any rate, the babies tolerated labor and delivery well, and they were fine–but I had a bad PPH. It was likely due to a combination of carrying twins, needing pitocin augmentation and a long labor. For months after, I was more exhausted and drained than I should have been, due to anemia. To this day, I wonder how the recovery might have been if I’d chosen the Csection upon arrival to the hospital—it might have been easier. The point of this rambling story is that 1)vaginal birth is not risk free and 2)I’m glad I had the autonomy to choose, even if it was a crap-shoot.

Gatita

More thoughts: what really upset me about this piece is she’s running around trying to convince women who’re happy with their hospital births that they were actually abused and should feel miserable instead. That’s fucking evil.

Who?

It’s just marketing-she’s drumming up business.

namaste863

Your basic Gaslighting. These people are shameless.

Sean Jungian

A technique (gaslighting) also used heavily by abusive people.

namaste863

That’s why I made note of it.

namaste863

That’s why I thought it worth mentioning. The comparison is eerie.

Rose Magdalene

I had an emergency c-section with my first after a failed “natural” labor in a hospital. I did everything “right,” no interventions other then intermittent fetal monitoring. Still end up with a c-section because my daughter sat on her cord. So cascade of interventions my a**.

Any who. I drank heavily from the NCB kool aid during that first pregnancy. (That was the crowd I was hanging with at the time.) So I already felt guilty and like a failure. And it really did feel like all the NCB people I was around were mining for things from my birth experience to feel outraged over. I already had so many negative feelings at that time about a birth that really wasn’t that bad in hindsight. People’s need to heap more negativity onto my experience was bizarre and not helpful. Not at all.

Rosalind Dalefield

It reminds me of that ‘false memory syndrome’ when people got convinced they had been sexually abused as children when they hadn’t been.

Gatita

I loved loved loved my epidural. I remember when my son was crowning and it hurt despite the meds my doctor said yeah, this is the part where women without meds are screaming. No thanks. I got to feel my son’s descent and birth without being insane from pain. #TeamDrugs4Lyfe

BeatriceC

I was so happy to get an epidural with my oldest that I proposed to the (female) anesthesiologist, much to the chagrin of my then-husband.

Spamamander

I believe I told the anesthesiologist that I loved him during the birth of my first child, after I gave in and sheepishly asked my CNM if it was ok for me to get an epidural after the first 14 hours of labor. (Her response, “Of course!” and waving down the anesthesiologist to come get me first since the woman down the hall had a history of small babies)

Sean Jungian

Loved it! Love the epidural so much. Never have a baby without one! 🙂

Dinolindor

Yup. I told my husband that if we have a 3rd and for some reason there’s no way to guarantee an epidural C-SECTION ALL THE WAY. I have zero need to feel drug-free vaginal birth.

rosewater1

The NCB movement seems to advocate freedom of choice as long as you do it their way. Which is no choice at all. Autonomy is autonomy, whether you like the choice or not.

LaMont

Well, there are choices that are objectively terrible, like homebirth over hospital birth, and just saying “you have the right” (which most people on this blog do) is a far cry from accepting the choice itself. Having all the facts sometimes isn’t a balanced thing, when the choices are so disparate. It seems like NCB people actually think that the c-section/epidural/etc. choice is *worse* and that doctors are just pushing those interventions on patients despite well-established negative effects. If a certain drug was clearly, unambiguously more dangerous than helpful, we’d hope that the medical community would ban it rather than keep it around in the name of “choice” – that’s just not the case for birth interventions, though near everyone seems to think so.

Daleth

It seems like NCB people actually think that the c-section/epidural/etc. choice is *worse*

I’ve never had this conversation before but I’d like to run the math by an NCB type. Like so:
– Epidurals increase the risk of fetal death or brain damage by 0%. No increase at all.
– Likewise, c-sections increase the risk of fetal death or brain damage by 0%.
– But home birth increases the risk of fetal death by approximately 400% (see the Cornell study of ALL low-risk babies born in the US from 2007-09), and increases the risk of brain damage by 16.9 times.

Um…

LaMont

Daleth, I’m pretty sure those masculine, mathy numbers are just part of the patriarchy. 🙂

MI Dawn

OK, Devil’s Advocate: c/s *can* possibly increase the risk of fetal death, as well as maternal death. Babies can be cut and otherwise injured during a C/S.

Not saying it isn’t a good option, just saying we don’t want to swing too far the other way and make them sound harmless to mom and baby, also.

And yes, C/S is safer statistically than home birth. No argument from me there.

The Bofa on the Sofa

OK, Devil’s Advocate: c/s *can* possibly increase the risk of fetal death, as well as maternal death. Babies can be cut and otherwise injured during a C/S.

But the risk of that happening is lower than their risk of being injured in a vaginal delivery, so that doesn’t constitute an increased risk. It means that it isn’t “No risk” but the risk is lower, not increased

Roadstergal

Ja, it’s basically a negative increase in risk to the fetus that Daleth rounded to zero.

MI Dawn

The Bofa on the Sofa: But the risk of that happening is lower than their risk of being injured in a vaginal delivery, so that doesn’t constitute an increased risk.
Roadstergal:Ja, it’s basically a negative increase in risk to the fetus that Daleth rounded to zero.

Those are honestly intriguing statements. I’ve just never seen any statistics saying that in all my career. However, I have been away from the research for a while. Do you have some references I can pull to read? I know that C/S can lower risk to mom and baby in some circumstances, but compared to all vaginal births? I’d be very interested to read that.

Again – I believe and support bodily autonomy – if a woman wants a c/s or a vaginal delivery, unmedicated, epidural, whatever – I’d support that. However, also given that I have 2 daughters thinking about childbearing in the next few years, I’d love to know more to let THEM know more. I just found those statements interesting.

Gatita

If you search the site you will find studies. You can also email Amy directly. She’s really good about getting back to people. My understanding is that maternal morbidity and mortality increase with C-section but decrease for the baby. You also have to weigh whether the mother plans to have three or more children since the risk of uterine rupture increases with each potency and C-section.

Unfortunately, it wasn’t published as an official paper as far as I know, but the Birth Trauma Association looked at over 2 million births in the UK and noted that if you looked at all prelabor C-sections vs all attempted vaginal births (including those that went to emergency C/S), you saw a slight decrease in maternal mortality as well, suggesting that a prelabor C-section might be safer for the mom as well vs attempting vaginal.

Thanks! I’ve been more active lately; job change has given me a bit more time.

Daleth

Devil’s Advocate: c/s *can* possibly increase the risk of fetal death,
as well as maternal death. Babies can be cut and otherwise injured
during a C/S.

Nope. CS do not and cannot INCREASE the risk of the child’s death.

Yes, babies can be cut by the scalpel. Perhaps other injuries actually caused by the CS itself are also possible (doctors, fill me in). But you haven’t identified any way that they can be *killed* by a c-section, much less any reason to believe that that might be more likely to happen than being killed by vaginal birth.

Here’s a study. When you start reading the abstract it sounds like babies can be injured in several ways during CS deliveries, but then you realize that they are including injuries sustained during the attempt to vaginally deliver them:

“A total of 37,110 cesarean deliveries were included in the registry, and 418 (1.1%) had an identified fetal injury. The most common injury was skin laceration (n = 272, 0.7%). Other injuries included cephalohematoma (n = 88), clavicular fracture (n= 11), brachial plexus (n = 9), skull fracture (n = 6), and facial nerve palsy (n = 11)…. deliveries with a failed forceps or vacuum attempt had the highest rate of injuries…. and the lowest rate occurred in the elective repeat cesarean group.”http://www.ncbi.nlm.nih.gov/pubmed/17012450

NOTICE: no baby deaths. Almost 40,000 CS births, including some crash sections, and no deaths.

The abstract doesn’t break this down, but cephalohematoma is caused by vacuum delivery. Skull fracture and facial nerve palsy are both caused by forceps. Only the 272 “lacerations,” from the scalpel, are clearly caused by the CS itself and not the unsuccessful attempt at vaginal birth. And that’s 272 lacerations out of almost 40,000 births.

And in addition to the fact that most of the types of injuries listed are consequences of attempting vaginal delivery, not consequences of the c-section itself, it’s also clear that trying to deliver vaginally and ending up needing an emergency c-section–especially a crash section–caused some injuries because the “type of uterine incision was associated with fetal injury, 3.4% ‘T’ or ‘J’ incision, 1.4% for vertical incision, and 1.1% for a low transverse (P = .003), as was a skin incision-to-delivery time of 3 minutes or less.”

Low transverse incisions are used for planned CS and emergent ones where you don’t need to rush. The other incisions get the baby out faster so are used when that’s what you need to do. And a decision-to-incision time of 3 minutes is incredibly fast, clearly crash sections done on mothers who were already in the OR while they were laboring.

Moral of the story? With the exception of scalpel lacerations, injuries suffered by babies born through c-section are typically caused by the attempted vaginal birth or the delay in deciding to do a c-section (i.e. persisting with labor until a dire emergency requires a crash or near-crash CS). Which is why planned CS have such a low injury rate.

Manabanana

EXACTLY.

mythsayer

I always say they are like Henry ford. Any color you like, as long as it’s black.

The support of NCB for women’s autonomy is both an inch wide and an inch deep. Women’s autonomy in NCB means:
– getting prenatal care from a midwife along with an obligatory statement about how much you liked the appointments because it was like being with a friend.
– being comforted from any real fears you have by the statement “Your body knows how to give birth”.
– a willingness to undergo labor and delivery without any pain medications. Added bonus points if you are clearly out of your mind from the pain based on your memories and the photos taken by the birth photographer and you tell the story as a form of redemptive pain.
-breastfeeding your baby until they’re at least a verbal toddler.
– being deeply angst-filled and guilty about any deviation from the script.

It’s like a religion – but there’s no deity you can appeal to for succor or reprieve.

moto_librarian

Absolutely. I’m having a particularly hard time with people who complain about the risks of c-sections who act like vaginal birth is some perfect process. It’s not. If anyone had bothered to give me the actual risks and benefits of vaginal birth, I would have had an elective c-section with my first. I just turned 38, and I go to see a pelvic health specialist next month. I’ve been doing some reading (I have access to a lot of the peer-reviewed literature for obstetrics and gynecology), and I know that I’m probably looking at reconstructive surgery for a rectocele. I cannot empty my bowels completely without splinting, and I have lost the ability to reliably sense when I need to defecate. I just turned 38, so this isn’t something caused by aging. I’m upset and frankly a bit depressed about it.

Gatita

I’m so sorry you are going through that.

moto_librarian

Thanks, Gatita. It’s been getting progressively worse over the past two years, and I finally decided that I had to quit ignoring it. It really does impact your quality of life.

BeatriceC

Hugs. At 40 I’m having similar, but less severe issues. I can’t sneeze or cough without peeing myself, bowel movements are extremely painful all the time, though keeping my feet on a step stool helps, sex is sometimes randomly painful in weird ways. Doctors just keep recommending kegels, but hell, I do so many of those I can (ummm, how do I put this delicately…I can’t, so whatever), make men orgasm just by squeezing them. While that’s a neat party trick, I’d rather be able to sneeze without making a mess.

moto_librarian

I was having stress urinary incontinence after my second child was born, and physiotherapy really helped. Kegels only do so much. You have to learn to kegel while simultaneously tightening your core muscles when sneezing or coughing to prevent urinary incontinence. It can become automatic. You might see if you could get a referral.

BeatriceC

I can sort of keep it under control if I kegle, tighten my abdomen and cross my legs at the same time. That works about 80% of the time *if* I can manage all that in time to sneeze. That’s a big if.

fiftyfifty1

I like to think that all the best people splint. You may not have chosen to join this club, but since you are here, a warm welcome to you!

Megan

This is what I was thinking while reading the piece yesterday. Would this woman, who herself admitted that she cares more about how other women give birth than the women themselves do, advocate for my right to have a MRCS? Granted, I had a medical indication for my recent CS but it was my choice as well. I somehow doubt she’d be fighting for my right to have a CS.

In fact it seemed her entire article was just to let us all know that the purpose of doulas, in her opinion, is to argue with everything a woman’s medical provider suggests and to instill doubt in the woman’s mind about her provider’s “real intentions.” Sorry, but I used to do OB and I can think of one provider I’ve ever worked with that routinely practiced the way they accuse us all of doing, and frankly, many of his early term inductions or CS were because that’s what the patient wanted and he was known for that, so one could argue he was more of a feminist than this author. The majority of physicians in general, have the true safety of their patients (moms and babies) at heart.

I was struck by the fact that the author could care less what the laboring woman actually wanted during labor and delivery and the fact that the author seemed completely unconcerned with chance that a baby could be injured or die because of the author’s crusade to get her birth jollies on.

Sean Jungian

The cavalier attitude is far more horrifying to me than ANY brusqueness I ever encountered in a conventional medical setting.

Yes, I believe some medical professionals could do with some work on their bedside manner, however, I’ve never doubted their commitment to a patients care, health and well-being.

EmbraceYourInnerCrone

Where does a doula, who is NOT a Health Care Provider and is NOT trained as one, get off arguing with with the medical providers? Asking reasoned question on the woman’s behalf (example: if the woman is thinking about an epidura,l maybe asking if there are any after effects to look out for, etc or emphasizing that the woman has asked not to have an episiotomy IF one can be safely avoided, would seem like advocating for your client) is fine. Arguing with the doctor seems like going too far

Cody

Actually, doulas should not be asking the medical provider any of those questions. It doesn’t mean we can speak to doctors like normal people, but we aren’t supposed to speak to medical care providers on the client’s behalf. I speak to nurses more frequently, but in this context. “So and so would like an epidural and sent me out to get you” or am I allowed to offer so and so something to eat?” etc.

Daleth

You said it!!!

Amy Tuteur, MD

Dr. Amy Tuteur is an obstetrician gynecologist. She received her undergraduate degree from Harvard College in 1979 and her medical degree from Boston University School of Medicine in 1984. Dr. Tuteur is a former clinical instructor at Harvard Medical School. She left the practice of medicine to raise her four children. Her book, Push Back: Guilt in the Age of Natural Parenting (HarperCollins) was published in 2016. She can be reached at DrAmy5 at aol dot com...
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